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Alshalah A, Williams DJ, Ferrario A. From fangs to antidotes: A scoping review on snakebite burden, species, and antivenoms in the Eastern Mediterranean Region. PLoS Negl Trop Dis 2024; 18:e0012200. [PMID: 39083539 PMCID: PMC11335162 DOI: 10.1371/journal.pntd.0012200] [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: 10/27/2023] [Revised: 08/20/2024] [Accepted: 05/07/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Snake bites cause considerable morbidity and mortality worldwide, yet evidence from low- and middle-income countries remains fragmented. This is particularly the case in Eastern Mediterranean Region where available data on snake bites is relatively weak. Without reliable data, it is difficult to make the case for greater visibility and investment to address the snakebite burden in this Region. A scoping review was therefore conducted to summarize evidence on snake bites in countries of the Eastern Mediterranean. METHODOLOGY/PRINCIPAL FINDINGS The review employed manual and electronic searching methods of four databases plus Google Scholar, ultimately including 196 records from 20 countries published between 2000 and 2023. More than half originated from Iran, Morocco, and Pakistan. Many records lacked information on permanent sequalae, disability, snake species, and types and sources of antivenoms. When identified, offending snakes belonged to 30 species. Use of more than 12 types of antivenoms were described across the Region, and some were not specific to indigenous species. CONCLUSION/SIGNIFICANCE Despite the relatively large number of publications identified, the data were concentrated in just a few countries in the Region, and there was little or no information available for the remainder. As is the case worldwide, disability associated with snake bites was poorly characterized and quantified across the Region. There is an urgent need for concrete action at national and regional levels to enhance epidemiological surveillance, research, and the collection of clinical, disability and outcomes data to inform policy and public health investment. Greater regional cooperation and collaboration is also crucial for addressing this neglected disease throughout the Region.
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Affiliation(s)
- Ali Alshalah
- Information Systems for Health Unit, Department of Science, Information and Dissemination, WHO Regional Office for Eastern Mediterranean, Cairo, Egypt
| | - David J. Williams
- Regulation and Prequalification Department, World Health Organization, Geneva, Switzerland
| | - Alessandra Ferrario
- Information Systems for Health Unit, Department of Science, Information and Dissemination, WHO Regional Office for Eastern Mediterranean, Cairo, Egypt
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Stephen S, Mohanty CR, Radhakrishnan RV, Issac A, Jacob J, Krishnan N, Vr V, Guru S, Muhammed Shaji I, Aggarwal A. Clinico-Epidemiological Profile, Trends, and Health-Related Outcomes of Snakebite Victims: A One-Year Prospective Study from Eastern India. Wilderness Environ Med 2024; 35:155-165. [PMID: 38634117 DOI: 10.1177/10806032241239628] [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] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Snakebite envenomation is a significant life-threatening public health problem in Southeast Asia (SEA). In this region, India reported the largest number of snakebite deaths from 2000 to 2019 (1.2 million), with an average of 58,000 deaths yearly. METHODS This prospective observational study was carried out among snakebite victims at the emergency department (ED) of a tertiary care public sector hospital in eastern India. RESULTS A total of 145 cases of venomous snakebite were investigated. More than half (n = 81, 56%) of the snakebite victims were between 17 to 45 years. Most of the snakebite victims were male (68%) and were farmers (53%) by occupation. The majority of snakebites occurred during the daytime (76%) and while outdoors (67%). Most victims sustained a bite on the lower extremity (71%). The peak incidence of snakebites occurred from June to September (69%). Three-quarters of all patients were unaware of the required first aid measures following a snakebite. Among the 145 venomous snakebites, 48 were presumptively identified as the Indian cobra, 32 by the Indian krait, 56 by the Russel's viper, and 9 by saw-scaled viper. The mean duration from the snakebite to the onset of systemic effects in the Indian cobra was 52 ± 14.28 min, 66 ± 18.35 min in the Indian krait, 42 ± 13.47 min in Russel's viper, and 48 ± 16.38 min in saw-scaled viper. Respiratory failure was the commonly observed complication following an elapid envenomation. The mortality rate was 2.1% among the patients treated with antivenom. CONCLUSIONS Snakebite is considered an occupational hazard in India, commonly affecting the young population in their productive period. The peak incidence was during monsoon season, and the majority had neurotoxic envenomation following an elapid bite (55%) that contributed to the increased mortality and morbidity among young adults. Of the 145 patients, the majority (84%) recovered fully with treatment; 16% of the victims developed morbidity viz cellulitis, respiratory failure, acute renal failure, compartment syndrome, local tissue necrosis, intracerebral hemorrhage, and disseminated intravascular coagulation. Appropriate first aid measures and timely medical intervention can significantly improve the treatment outcome following snakebites.
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Affiliation(s)
- Shine Stephen
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | | | - Alwin Issac
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Jaison Jacob
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Nadiya Krishnan
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Vijay Vr
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Raebareli, India
| | - Satyabrata Guru
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Achala Aggarwal
- Department of Nursing Services, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Afroz A, Siddiquea BN, Chowdhury HA, Jackson TNW, Watt AD. Snakebite envenoming: A systematic review and meta-analysis of global morbidity and mortality. PLoS Negl Trop Dis 2024; 18:e0012080. [PMID: 38574167 PMCID: PMC11020954 DOI: 10.1371/journal.pntd.0012080] [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: 12/03/2023] [Revised: 04/16/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Snakebite envenoming represents a significant and often neglected public health challenge, particularly in rural communities across tropical and subtropical regions. An estimated 1.2-5.5 million people are envenomed by snakebites annually. More than 125,000 of these bites are fatal, and 3-4 times as many results in disability/disfigurement. Despite its prevalence, collecting accurate epidemiological data on snakebite is challenging. This systematic review and meta-analysis collates global epidemiology data on snakebite morbidity and mortality. METHODS Medline, Embase, Cochrane and CINAHL Plus databases were searched for articles published between 2001-2022. Pooled incidence and mortality were obtained using random effects modelling, heterogeneity (I2) was tested, and sensitivity analyses performed. Newcastle-Ottawa Scale assessed study quality. RESULTS Out of the four databases, 5,312 articles were found. After removing duplicates, 3,953 articles were screened by title and abstract and 65 articles containing information on snakebite epidemiology, encompassing 663,460 snakebites, were selected for analysis. The people most at risk for snakebite were men (59%), engaged in agricultural labour (27.5%), and residing in rural areas (66.7%). More than half (57%) of the reported bites resulted in envenoming. Incidents occurred frequently in the summer season (38.5%), during daytime (56.7%), and bites were most often to the lower limb (56.4%). Envenoming severity was frequently mild (46.7%), treated in hospital (68.3%), and was treated with anti-venom (64.7%). The pooled global incidence and mortality was 69.4 /100,000 population (95%CI: 36.8 to 101.9) and 0.33/100,000 population (95%CI, 0.14 to 0.52) per year, respectively. Stratified by continents, Asia had the highest incidence of 130.7/100,000 population (95%CI: 48.3 to 213.1) while Europe has the lowest with 0.7/100,000 population (95%CI: -0.2 to 1.5). The highest mortality was reported in Asia at 0.96/100,000 population (95% CI: 0.22 to 1.70), and Africa 0.44/100,000 population (95%CI: -0.03 to 0.84). Incidence was highest among inhabitants of lower-middle-income countries 132.7/100,000 population (95%CI: 55.4 to 209.9) while mortality was highest in low-income countries at 0.85/100,000 population (95% CI: -0.06 to 2.31). CONCLUSION Incidence and mortality rates noted here highlight the global impact of snakebite and underscore the critical need to address the burden of snakebite envenoming. It also reveals that while reported snakebite incidence was higher in lower-middle-income countries, the burden of mortality was greatest among inhabitants of low-income countries, again emphasising the need for greater efforts to tackle this neglected tropical disease.
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Affiliation(s)
- Afsana Afroz
- Australian Venom Research Unit, Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Bodrun Naher Siddiquea
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Hasina Akhter Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Timothy NW Jackson
- Australian Venom Research Unit, Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Andrew D. Watt
- Australian Venom Research Unit, Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Méndez-Molina R, Villela-Oriza AK, Espinosa-Couoh AA, Huchim-Lara O. Snakebites epidemiology in Mexico: a 13-year ecological analysis. Trans R Soc Trop Med Hyg 2024; 118:118-126. [PMID: 37746875 DOI: 10.1093/trstmh/trad070] [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: 05/13/2023] [Revised: 06/30/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Globally, snakebites have a significant impact on public health and represent substantial costs for health services. Their severity is particularly relevant in developing countries due to the lack of resources and accessibility to health facilities. Additionally, the number of cases may be underestimated, highlighting the urgent need for improved prevention measures. METHODS An observational ecological study was undertaken using the records identified with X200-X209 codes registered in the Ministry of Health injuries database during 2010-2022. Variables included information related to the patient, the snakebite and the healthcare provided. Statistical analysis was carried out with STATA 16 and Microsoft Excel 2020. RESULTS A total of 10 420 snakebites were registered. The average number of cases per year was 788 (IQR 615, 875) and 82.74% occurred during the rainy season. The median age was 35 (IQR 19, 52) y and early adulthood was the most affected age group; bites were most common on the hand and in the living place. The Eastern region of Mexico registered the highest number of cases, with 3496 (33.71%) of snakebites. The lethality rate was 18.23 per 10 000. CONCLUSIONS Snakebites are a significant health problem in Mexico. Most injuries occur among men in early adulthood, in households and in the upper extremities.
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Dehghani R, Monzavi SM, Mehrpour O, Shirazi FM, Hassanian-Moghaddam H, Keyler DE, Wüster W, Westerström A, Warrell DA. Medically important snakes and snakebite envenoming in Iran. Toxicon 2023; 230:107149. [PMID: 37187227 DOI: 10.1016/j.toxicon.2023.107149] [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: 03/28/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
Snakebite is a common health condition in Iran with a diverse snake fauna, especially in tropical southern and mountainous western areas of the country with plethora of snake species. The list of medically important snakes, circumstances and effects of their bite, and necessary medical care require critical appraisal and should be updated regularly. This study aims to review and map the distributions of medically important snake species of Iran, re-evaluate their taxonomy, review their venomics, describe the clinical effects of envenoming, and discuss medical management and treatment, including the use of antivenom. Nearly 350 published articles and 26 textbooks with information on venomous and mildly venomous snake species and snakebites of Iran, were reviewed, many in Persian (Farsi) language, making them relatively inaccessible to an international readership. This has resulted in a revised updated list of Iran's medically important snake species, with taxonomic revisions of some, compilation of their morphological features, remapping of their geographical distributions, and description of species-specific clinical effects of envenoming. Moreover, the antivenom manufactured in Iran is discussed, together with treatment protocols that have been developed for the hospital management of envenomed patients.
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Affiliation(s)
- Ruhollah Dehghani
- Department of Environmental Health, Kashan University of Medical Sciences, Kashan, Iran; Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Mostafa Monzavi
- Medical Toxicology Center, Mashhad University of Medical Sciences, Mashhad, Iran; Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran; Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO, USA.
| | - Farshad M Shirazi
- Arizona Poison and Drug Information Center, University of Arizona, Tucson, AZ, USA
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Daniel E Keyler
- Department of Experimental & Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Wolfgang Wüster
- Molecular Ecology and Evolution at Bangor, School of Natural Sciences, Bangor University, Bangor, UK
| | | | - David A Warrell
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Kazemi SM, Al-Sabi A, Long C, Shoulkamy MI, Abd El-Aziz TM. Case Report: Recent Case Reports of Levant Blunt-Nosed Viper Macrovipera lebetina obtusa Snakebites in Iran. Am J Trop Med Hyg 2021; 104:1870-1876. [PMID: 33819174 PMCID: PMC8103458 DOI: 10.4269/ajtmh.20-1640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/29/2021] [Indexed: 11/07/2022] Open
Abstract
Envenomation and death resulting from snakebites represent a significant public health problem worldwide, particularly in tropical and subtropical regions. The WHO has defined snakebite as a neglected tropical health concern. Bites from Macrovipera lebetina obtusa usually cause life-threatening systemic hemodynamic disturbances, reduced functionality of the kidneys, and other serious symptoms, including hypotension shock, edema, and tissue necrosis, at the bite site. Herein, we highlight five cases of M. l. obtusa envenomation that presented with wide-ranging manifestations. Many recovered cases were left with long-term musculoskeletal disabilities. In a particular case, a 15-year-old male patient was envenomed in his palm by an 80-cm M. l. obtusa. Within 12 hours, swelling extended to near the shoulder. Fasciotomy was performed on the forearm and part of the upper arm of this patient. Symptoms of severe localized pain and swelling, dizziness, weakness, low blood pressure, and itching around the bite area were documented. The patient remained in the hospital for 13 days.
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Affiliation(s)
| | - Ahmed Al-Sabi
- College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait
| | - Chengbo Long
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences, Kunming Institute of Zoology, KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Mahmoud I. Shoulkamy
- Guangdong Key Laboratory of Genome Stability and Disease Prevention, Shenzhen University School of Medicine, Shenzhen, China;,Zoology Department, Faculty of Science, Minia University, El-Minia, Egypt
| | - Tarek Mohamed Abd El-Aziz
- Zoology Department, Faculty of Science, Minia University, El-Minia, Egypt;,Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas,Address correspondence to Tarek Mohamed Abd El-Aziz, Department of Cellular and Integrative Physiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900. E-mail:
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Onyishi IE, Nwonyi SK, Pazda A, Prokop P. Attitudes and behaviour toward snakes on the part of Igbo people in southeastern Nigeria. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 763:143045. [PMID: 33121773 DOI: 10.1016/j.scitotenv.2020.143045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 06/11/2023]
Abstract
Snakes play a crucial role in natural ecosystems, providing ecological services to people by decreasing rodent populations which may cause disease transmission and impair agricultural production. Despite these benefits, snakes are historically a target of persecution and negative attitudes across cultures, and many of them are threatened. Understanding the predictors of snake-human conflicts is essential to improve conservation efforts. We investigated the degree to which emotions, myth beliefs, experience with snakes (via exposure, bites, and knowledge of mortality from a snakebite), and education would predict attitudes toward snakes in a sample of southeastern Nigerian people. We further examined whether attitudes would predict intentional killing of snakes. Ordinal regression analyses revealed that fear, disgust, and belief in the myth that snakes are evil were related to low tolerance of snakes. More frequent encounters with snakes and higher education were associated with higher tolerance of snakes. Furthermore, higher tolerance of snakes was associated with a reduced likelihood of intentionally killing snakes, even when controlling for the influence of the other psychological and experiential variables. Wildlife management education interventions may be important to change attitudes and decrease intentional killing of snakes.
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Affiliation(s)
- Ike E Onyishi
- Department of Psychology, University of Nigeria, Nsukka, Nigeria.
| | - Sampson K Nwonyi
- Department of Psychology and Sociological Studies, Ebonyi State University, Abakaliki, Nigeria
| | - Adam Pazda
- University of South Carolina Aiken, Department of Psychology, 471 Univ Pkwy, Aiken, SC 29801, USA
| | - Pavol Prokop
- Department of Environmental Ecology, Faculty of Natural Sciences, Comenius University, Ilkovičova 6, 842 15 Bratislava, Slovakia; Institute of Zoology, Slovak Academy of Sciences, Dúbravská cesta 9, 845 06 Bratislava, Slovakia.
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Kadkhodazadeh M, Rajabibazl M, Motedayen M, Shahidi S, Veisi Malekshahi Z, Rahimpour A, Yarahmadi M. Isolation of Polyclonal Single-Chain Fragment Variable (scFv) Antibodies Against Venomous Snakes of Iran and Evaluation of Their Capability in Neutralizing the Venom. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2021; 19:288-296. [PMID: 33680030 PMCID: PMC7758004 DOI: 10.22037/ijpr.2019.14400.12358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Several species of dangerous snakes are found in Iran and, according to the Emergency Response Center of Iran from 2002 to 2011, 53,787 Iranians have suffered from snakebite. Although the mortalities caused by snakebite are very low, snakebite-related amputations are still a major concern. Currently, anti-venom polyclonal antibodies derived from animals, such as horses are used to treat snakebites; however, in some cases they can cause anaphylactic shock and serum sickness. In line with this premise, generation of recombinant anti-venom antibodies can be considered as an alternative strategy. Single-chain fragment variable (scFv) antibodies offer several advantages compared to the whole antibodies, including ease of production, high affinity and specificity. In the present study, scFv antibodies were selected against the venom of the most poisonous snakes in Iran using phage display technology. Phage particles harboring anti-venom specific scFv were separated and scFv antibodies were produced in bacteria. In-vitro assay showed that polyclonal scFvs specifically bind to the venom. Furthermore, in-vivo experiment in mice BALB/c indicated effective toxin neutralization using 20 µg of polyclonal scFv. Our study indicates the neutralizing capacity of anti-venom polyclonal scFvs, although further neutralization assays are needed to confirm their effectiveness.
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Affiliation(s)
- Maryam Kadkhodazadeh
- Department of Clinical Biochemistry, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Rajabibazl
- Department of Clinical Biochemistry, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Motedayen
- Department of Serotherapy, Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Solmaz Shahidi
- Department of Clinical Biochemistry, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ziba Veisi Malekshahi
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University, Tehran, Iran
| | - Azam Rahimpour
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maral Yarahmadi
- Department of Clinical Biochemistry, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mahmoudi GA, Ahadi M, Fouladvand A, Rezaei B, Bodagh Z, Astaraki P. Evaluation of Allergic Reactions Following Intravenous Infusion of Polyvalent Antivenom in Snakebite Patients. Antiinflamm Antiallergy Agents Med Chem 2021; 20:367-372. [PMID: 33563188 DOI: 10.2174/1871523020666210204143756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Antivenom is a gold-standard treatment for snakebite envenoming. However, adverse reactions to snake antivenom are common in many parts. OBJECTIVE The aim of this study was to evaluate the allergic reactions following intravenous administration of antivenom sera. METHODS This was retrospective study, conducted snakebites patients referred to the Rahimi Hospital in Khorramabad. The files of these patients were accessed for demographic data, snakebite-related data, treatment provided, clinical presentation and allergic reaction status as a result of antivenom treatment. RESULTS 141 cases were investigated including 73.8% male and 26.2% female patients. The mean age of the patients was 38.1±17.1years. Age group 30-39 years accounted for highest number of snakebite cases (24.1%). A majority of victims (89.4%) were from the rural areas. Most of the patients (51.8%) were bitten in the spring and highest number of snakebite were reported in May (39.1%). The most common site of snakebite was lower extremities (50.4%) and upper extremities (44.7%). Among clinical feature of snakebite, pain was the most prevalent in 135 cases (95.7%) followed by swelling (83.7%). The mean antivenom vials used were 6.5±3.7 vials. Allergic reactions occurred in 6 patients (4.26%); reactions were mild in 5 patients and sever in 1patient. The commonest presentation was maculopapular rash (1.4%) and the least common were headache (0.71%), nausea (0.71%), fever (0.71) and hypotension (0.71%). CONCLUSION Snakebite is one of the significantlife-threatening environmental events.Immediate antivenom treatment can reduce mortality however, patients should be carefully monitored for adverse allergic reactions.
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Affiliation(s)
- Ghafar-Ali Mahmoudi
- Department of Internal Medicine, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad. Iran
| | - Maryam Ahadi
- Department of Internal Medicine, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad. Iran
| | - Ali Fouladvand
- Department of Pediatrics, School of Medicine, Lorestan University of Medical Sciences, Khorramabad. Iran
| | - Bareza Rezaei
- Department of Emergency Medicine, School of Medicine, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah. Iran
| | - Zahra Bodagh
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad. Iran
| | - Peyman Astaraki
- Department of Internal Medicine, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad. Iran
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Chowdhury A, Zdenek CN, Dobson JS, Bourke LA, Soria R, Fry BG. Clinical implications of differential procoagulant toxicity of the palearctic viperid genus Macrovipera, and the relative neutralization efficacy of antivenoms and enzyme inhibitors. Toxicol Lett 2021; 340:77-88. [PMID: 33412251 DOI: 10.1016/j.toxlet.2020.12.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Abstract
Species within the viperid genus Macrovipera are some of the most dangerous snakes in the Eurasian region, injecting copious amounts of potent venom. Despite their medical importance, the pathophysiological actions of their venoms have been neglected. Particularly poorly known are the coagulotoxic effects and thus the underlying mechanisms of lethal coagulopathy. In order to fill this knowledge gap, we ascertained the effects of venom upon human plasma for Macrovipera lebetina cernovi, M. l. lebetina, M. l. obtusa, M. l. turanica, and M. schweizeri using diverse coagulation analysing protocols. All five were extremely potent in their ability to promote clotting but varied in their relative activation of Factor X, being equipotent in this study to the venom of the better studied, and lethal, species Daboia russelii. The Insoserp European viper antivenom was shown to be highly effective against all the Macrovipera venoms, but performed poorly against the D. russelii venom. Reciprocally, while Daboia antivenoms performed well against D. russelii venom, they failed against Macrovipera venom. Thus despite the two genera sharing a venom phenotype (Factor X activation) driven by the same toxin type (P-IIId snake venom metalloproteases), the surface biochemistries of the toxins differed significantly enough to impede antivenom cross- neutralization. The differences in venom biochemistry were reflected in coagulation co-factor dependence. While both genera were absolutely dependent upon calcium for the activation of Factor X, dependence upon phospholipid varied. The Macrovipera venoms had low levels of dependence upon phospholipid while the Daboia venom was three times more dependent upon phospholipid for the activation of Factor X. This suggests that the sites on the molecular surface responsible for phospholipid dependence, are the same differential sites that prevent inter-genera antivenom cross- neutralization. Due to cold-chain requirements, antivenoms may not be stocked in rural settings where the need is at the greatest. Thus we tested the efficacy of enzyme inhibitor Prinomastat as a field-deployable treatment to stabilise patients while being transported to antivenom stocks, and showed that it was extremely effective in blocking the Factor X activating pathophysiological actions. Marimastat however was less effective. These results thus not only shed light on the coagulopathic mechanisms of Macrovipera venoms, but also provide data critical for evidence-based design of snakebite management strategies.
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Affiliation(s)
- Abhinandan Chowdhury
- Toxin Evolution Lab, School of Biological Science, University of Queensland, St. Lucia, QLD, 4072, Australia; Department of Biochemistry & Microbiology, North South University, Dhaka, 1229, Bangladesh
| | - Christina N Zdenek
- Toxin Evolution Lab, School of Biological Science, University of Queensland, St. Lucia, QLD, 4072, Australia
| | - James S Dobson
- Toxin Evolution Lab, School of Biological Science, University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Lachlan A Bourke
- Toxin Evolution Lab, School of Biological Science, University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Raul Soria
- Inosan Biopharma, S.A. Arbea Campus Empresarial, Edificio 2, Planta 2, Carretera Fuencarral a Alcobendas, Km 3.8, 28108, Madrid, Spain
| | - Bryan G Fry
- Toxin Evolution Lab, School of Biological Science, University of Queensland, St. Lucia, QLD, 4072, Australia.
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Al-Sadoon MK, Fahad Albeshr M, Ahamad Paray B, Rahman Al-Mfarij A. Envenomation and the bite rate by venomous snakes in the kingdom of Saudi Arabia over the period (2015-2018). Saudi J Biol Sci 2021; 28:582-586. [PMID: 33424343 PMCID: PMC7783841 DOI: 10.1016/j.sjbs.2020.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/02/2022] Open
Abstract
Snakebite being medical emergency and known cause for increased mortality needs assessment and treatment on high-priority bases, even in patients of snakebite who appear fine initially. The current retrospective study presents the snake bites in Saudi Arabia from 2015 to 2018 reported by General Administration of Statistics and Information, Ministry of Health, Kingdom of Saudi Arabia. The data presented in the current study, was extracted, analyzed, and reported after getting ethical approval from institutional committee. Totally, 14,679 cases of snakebites were reported during the four-year study period, with a higher prevalence in males (80%) in their productive age. Most patients were within the age group between 25 and 44 followed by 44 to 64 years. The majority of snakebite affected inhabitants were reported from farms of the rural areas, commonly during night hours of spring and summer seasons when snakes are very active. Only 36 (0.24%) patients out of 14,679 were reported dead and 14,643 (99.63%) were discharged after the treatment. Awareness among the general public should be encouraged and early diagnosis and usage of proper snake antivenoms could be life-saving. The delay in appropriate treatment can lead to significant morbidity and mortality.
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Affiliation(s)
- Mohammed K. Al-Sadoon
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Mohammed Fahad Albeshr
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Bilal Ahamad Paray
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Abdul Rahman Al-Mfarij
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
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Yousefi M, Kafash A, Khani A, Nabati N. Applying species distribution models in public health research by predicting snakebite risk using venomous snakes' habitat suitability as an indicating factor. Sci Rep 2020; 10:18073. [PMID: 33093515 PMCID: PMC7582189 DOI: 10.1038/s41598-020-74682-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/05/2020] [Indexed: 12/29/2022] Open
Abstract
Snakebite envenoming is an important public health problem in Iran, despite its risk not being quantified. This study aims to use venomous snakes' habitat suitability as an indicator of snakebite risk, to identify high-priority areas for snakebite management across the country. Thus, an ensemble approach using five distribution modelling methods: Generalized Boosted Models, Generalized Additive Models, Maximum Entropy Modelling, Generalized Linear Models, and Random Forest was applied to produce a spatial snakebite risk model for Iran. To achieve this, four venomous snakes' habitat suitability (Macrovipera lebetinus, Echis carinatus, Pseudocerastes persicus and Naja oxiana) were modelled and then multiplied. These medically important snakes are responsible for the most snakebite incidents in Iran. Multiplying habitat suitability models of the four snakes showed that the northeast of Iran (west of Khorasan-e-Razavi province) has the highest snakebite risk in the country. In addition, villages that were at risk of envenoming from the four snakes were identified. Results revealed that 51,112 villages are at risk of envenoming from M. lebetinus, 30,339 from E. carinatus, 51,657 from P. persicus and 12,124 from N. oxiana. Precipitation seasonality was identified as the most important variable influencing distribution of the P. persicus, E. carinatus and M. lebetinus in Iran. Precipitation of the driest quarter was the most important predictor of suitable habitats of the N. oxiana. Since climatic variables play an important role in shaping the distribution of the four venomous snakes in Iran, thus their distribution may alter with changing climate. This paper demonstrates application of species distribution modelling in public health research and identified potential snakebite risk areas in Iran by using venomous snakes' habitat suitability models as an indicating factor. Results of this study can be used in snakebite and human-snake conflict management in Iran. We recommend increasing public awareness of snakebite envenoming and education of local people in areas which identified with the highest snakebite risk.
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Affiliation(s)
- Masoud Yousefi
- Department of Environmental Science, Faculty of Natural Resources, University of Tehran, Karaj, Iran
| | - Anooshe Kafash
- Department of Environmental Science, Faculty of Natural Resources, University of Tehran, Karaj, Iran.
| | - Ali Khani
- Khorasan-e-Razavi Provincial Office of the Department of the Environment, Mashhad, Iran
| | - Nima Nabati
- Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Senek MZF, Kong SY, Shin SD, Sun KM, Kim J, Ro YS. Epidemiological profile and outcomes of snakebite injuries treated in emergency departments in South Korea, 2011–2016: a descriptive study. Trans R Soc Trop Med Hyg 2019; 113:590-598. [DOI: 10.1093/trstmh/trz050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/01/2019] [Accepted: 05/23/2019] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
Snakebite is a global public health crisis, but there are no nationwide data on snakebite in South Korea. The aim of this study was to describe the epidemiological profile and outcomes of snakebite cases in South Korea seasonally.
Methods
The selected subjects were patients of all ages with a chief complaint of snakebite who presented to participating emergency departments (EDs) between 1 January 2011 and 31 December 2016.
Results
A total of 1335 patients were eligible for the study. There were an average of 223 snakebite cases reported each year. Most snakebites occurred during the summer months (55.9%) in patients aged 40–59 y (36.3%) and males (61.5%). Snakebites occurred most frequently on Mondays (22.9%) between 12:00 and 17:59 h (42.0%) outdoors (57.9%) and in farm areas (20.7%). Over 82% of the bites were by venomous snakes across all seasons, and 66% of the patients visited EDs without using emergency medical services. Based on the excess mortality ratio-adjusted injury severity score, 88, 9.2 and 2.8% had mild, moderate and severe injuries, respectively. There were 10 fatalities during the study period.
Conclusion
This study provides essential information to understand and assess the burden and distribution of snakebites in South Korea and provides valuable information for developing appropriate prevention and control interventions to address it.
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Affiliation(s)
- Mohd Zaki Fadzil Senek
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Emergency and Trauma Department, Kemaman Hospital, Malaysia
| | - So Yeon Kong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyong Min Sun
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jungeun Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Krishnankutty SP, Muraleedharan M, Perumal RC, Michael S, Benny J, Balan B, Kumar P, Manazhi J, Kumar BD, Santhosh S, Thomas G, Gupta R, Zachariah A. Next-generation sequencing analysis reveals high bacterial diversity in wild venomous and non-venomous snakes from India. J Venom Anim Toxins Incl Trop Dis 2018; 24:41. [PMID: 30598660 PMCID: PMC6303853 DOI: 10.1186/s40409-018-0181-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 12/06/2018] [Indexed: 11/24/2022] Open
Abstract
Background The oral cavities of snakes are replete with various types of bacterial flora. Culture-dependent studies suggest that some of the bacterial species are responsible for secondary bacterial infection associated with snakebite. A complete profile of the ophidian oral bacterial community has been unreported until now. Therefore, in the present study, we determined the complete bacterial compositions in the oral cavity of some snakes from India. Methods Total DNA was isolated from oral swabs collected from three wild snake species (Indian Cobra, King Cobra and Indian Python). Next, the DNA was subjected to PCR amplification of microbial 16S rRNA gene using V3-region-specific primers. The amplicons were used for preparation of DNA libraries that were sequenced on an Illumina MiSeq platform. Results The cluster-based taxonomy analysis revealed that Proteobacteria and Actinobacteria were the most predominant phyla present in the oral cavities of snakes. This result indicates that snakes show more similarities to birds than mammals as to their oral bacterial communities. Furthermore, our study reports all the unique and common bacterial species (total: 147) found among the oral microbes of snakes studied, while the majority of commonly abundant species were pathogens or opportunistic pathogens to humans. A wide difference in ophidian oral bacterial flora suggests variation by individual, species and geographical region. Conclusion The present study would provide a foundation for further research on snakes to recognize the potential drugs/antibiotics for the different infectious diseases. Electronic supplementary material The online version of this article (10.1186/s40409-018-0181-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Saju Michael
- AgriGenome Labs Pvt. Ltd., SmartCity Kochi, Kakkanad, Kerala 682042 India
| | - Jubina Benny
- AgriGenome Labs Pvt. Ltd., SmartCity Kochi, Kakkanad, Kerala 682042 India
| | - Bipin Balan
- AgriGenome Labs Pvt. Ltd., SmartCity Kochi, Kakkanad, Kerala 682042 India
| | - Pramod Kumar
- AgriGenome Labs Pvt. Ltd., SmartCity Kochi, Kakkanad, Kerala 682042 India
| | - Jishnu Manazhi
- Department of Forests and Wildlife, Sulthan Batheri, Wayanad District, Kerala 673592 India
| | | | - Sam Santhosh
- AgriGenome Labs Pvt. Ltd., SmartCity Kochi, Kakkanad, Kerala 682042 India
| | - George Thomas
- SciGenom Research Foundation, Cheruthuruthy, Kerala 679531 India
| | - Ravi Gupta
- 4Medgenome Labs Pvt. Ltd., Narayana Health City, Bommasandra, Bengaluru, Karnataka 560099 India
| | - Arun Zachariah
- Department of Forests and Wildlife, Sulthan Batheri, Wayanad District, Kerala 673592 India
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15
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Ediriweera DS, Diggle PJ, Kasturiratne A, Pathmeswaran A, Gunawardena NK, Jayamanne SF, Isbister GK, Dawson A, Lalloo DG, de Silva HJ. Evaluating temporal patterns of snakebite in Sri Lanka: the potential for higher snakebite burdens with climate change. Int J Epidemiol 2018; 47:2049-2058. [PMID: 30215727 PMCID: PMC6280932 DOI: 10.1093/ije/dyy188] [Citation(s) in RCA: 16] [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] [Accepted: 08/20/2018] [Indexed: 11/14/2022] Open
Abstract
Background Snakebite is a neglected tropical disease that has been overlooked by healthcare decision makers in many countries. Previous studies have reported seasonal variation in hospital admission rates due to snakebites in endemic countries including Sri Lanka, but seasonal patterns have not been investigated in detail. Methods A national community-based survey was conducted during the period of August 2012 to June 2013. The survey used a multistage cluster design, sampled 165 665 individuals living in 44 136 households and recorded all recalled snakebite events that had occurred during the preceding year. Log-linear models were fitted to describe the expected number of snakebites occurring in each month, taking into account seasonal trends and weather conditions, and addressing the effects of variation in survey effort during the study and of recall bias amongst survey respondents. Results Snakebite events showed a clear seasonal variation. Typically, snakebite incidence is highest during November-December followed by March-May and August, but this can vary between years due to variations in relative humidity, which is also a risk factor. Low relative-humidity levels are associated with high snakebite incidence. If current climate-change projections are correct, this could lead to an increase in the annual snakebite burden of 31.3% (95% confidence interval: 10.7-55.7) during the next 25-50 years. Conclusions Snakebite in Sri Lanka shows seasonal variation. Additionally, more snakebites can be expected during periods of lower-than-expected humidity. Global climate change is likely to increase the incidence of snakebite in Sri Lanka.
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Affiliation(s)
- Dileepa Senajith Ediriweera
- Centre for Health Informatics, Biostatistics and Epidemiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- Centre for Health Informatics, Computing and Statistics, Lancaster University Medical School, Lancaster, UK
| | - Peter John Diggle
- Centre for Health Informatics, Computing and Statistics, Lancaster University Medical School, Lancaster, UK
| | | | | | | | | | - Geoffrey Kennedy Isbister
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Clinical Toxicology Research Group, University of Newcastle, Waratah, Australia
| | - Andrew Dawson
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Addiction Medicine, Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - David Griffith Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Epidemiologic prediction of snake bites in tropical south Iran: Using seasonal time series methods. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2018. [DOI: 10.1016/j.cegh.2018.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Alinejad S, Zamani N, Abdollahi M, Mehrpour O. A Narrative Review of Acute Adult Poisoning in Iran. IRANIAN JOURNAL OF MEDICAL SCIENCES 2017; 42:327-346. [PMID: 28761199 PMCID: PMC5523040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Poisoning is a frequent cause of referral to medical emergencies and a major health problem around the world, especially in developing countries. We aimed to review the epidemiology and pattern of adult poisoning in Iran in order to facilitate the early diagnosis and management of poisoning. The pattern of poisoning is different in various parts of Iran. Pharmaceutical compounds were the most common cause of poisoning in most parts of Iran. Pesticide-related toxicities were more common in northern agricultural regions, whereas bites and stings were seen more commonly in southern Iran. Carbon monoxide poisoning was common in cities with many motor vehicles such as Tehran and in colder climates such as in northern and western regions due to inadequately vented gas appliances such as stoves and heaters. Majoon Birjandi (containing cannabis) is a unique substance used in eastern Iran. Poisoning by opioids, tramadol, and pesticides (organophosphate and aluminum phosphide) has remained a common hazard in Iran. Poisoning-associated morbidity and mortality rates vary by region and have changed over time due to the introduction of new drugs and chemicals. Early diagnosis and proper treatment may be lifesaving; thus, understanding the general pattern of poisoning in different regions is important.
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Affiliation(s)
- Samira Alinejad
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Nasim Zamani
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran,Correspondence: Omid Mehrpour, MD; Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Moallem Avenue, Zip Code: 97178-53577, Birjand, Iran. Tel\Fax: +98 56 32381270
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18
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Farzaneh E, Fouladi N, Shafaee Y, Mirzamohammadi Z, Naslseraji F, Mehrpour O. Epidemiological study of snakebites in Ardabil Province (Iran). Electron Physician 2017; 9:3986-3990. [PMID: 28461874 PMCID: PMC5407232 DOI: 10.19082/3986] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/20/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Average annual incidence of snakebite worldwide is between 5.5 to 1.2 million, and at least 125,000 of them are fatal. In Iran, around 4,500–11,000 snakebites occur annually, and a small number of them are fatal. Snake bites can cause intoxity and immediate death in patients, and the aim of this study was to investigate the epidemiological study of snakebites in Ardabil Province. Methods This study was a cross-sectional that has been done on 67 snakebite patients who were admitted to the Imam Khomeini Hospital of Ardabil during 2008–2013. Information included: age and sex of victims, region of incidence, site of bite, hospitalized duration and symptoms. Data analyzed by descriptive statistical methods using SPSS version 19. Results There was significant difference between the two sexes (p=0.001). There was no significant difference between the mean age of male and female victims (p=0.68). Most of the victims were in the age group of 20–29 years (34.3%). All snakebites happened in rural areas. There was no significant relation between gender of victims and the residential location of victims (p=0.32). Most snakebites happened during 11 a.m. to 4 p.m. (32.8%). Most of the snakebites occurred in spring and summer seasons. Results showed that most of the bites in yearly months was seen in the summer season and the difference between seasons is significant. (p=0001). Most snakebites, with 38 cases (56.7%), were observed on lower limbs and among them right limbs with 20 cases (52.6%) had the greatest number. There was significant difference between organs of bites in victims because the most organs were in the right lower limb (p=0.002). Of all cases, 66 (98.5%) were injured by a species of viper snake. All patients, showed symptoms of pain, swelling, erythema and ecchymosis bite. Twenty-seven (40.3%) of all cases, suffered fainting. Nausea and vomiting were two other common symptoms. The antidote used in patients was 5.1±1.3 vials. The mean incidence rate of snakebite was an estimated 4.1 per 100000. Conclusions Possible risk factors include male gender and young age. It was also found that the stings reach peak in the morning and noon. These reports are all in rural areas, and mostly occurred in the warm months. Snakebites in rural parts around Ardebil were prevalent. Severe side effects were rare, but the incidence of other complications was common among the victims.
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Affiliation(s)
- Esmaeil Farzaneh
- Forensic Medicine and Toxicology Specialist, Associate Professor, Faculty of Medicine, Department of Internal Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nasrin Fouladi
- Ph.D. of Community Medicine, Associate Professor, Faculty of Medicine, Department of Community Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Yousef Shafaee
- Plastic Surgery Specialist, Assistant Professor, Faculty of Medicine, Department of Plastic Surgery, Iran University Of Medical Sciences, Tehran, Iran
| | | | - Farnaz Naslseraji
- Resident of Gynecology and Obstetrics, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Omid Mehrpour
- Fellowship of Medical Toxicology, Associate Professor, Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, Iran
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20
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Farooqui JM, Mukherjee BB, Manjhi SNM, Farooqui AAJ, Datir S. Incidence of fatal snake bite in Loni, Maharashtra: An autopsy based retrospective study (2004-2014). J Forensic Leg Med 2016; 39:61-4. [PMID: 26854851 DOI: 10.1016/j.jflm.2016.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/09/2015] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
Snake bite is a major public health problem specially in a rural region where agricultural work is the major source of employment. A retrospective study was undertaken of all cases of deaths due to snake bite autopsied at the Mortuary of Pravara Rural Hospital, Loni a rural area in Western Maharashtra over a period of 10 years from January 2004 to December 2014. Data of the study was gathered from autopsy reports and hospital records. The cases represented approximately 2.13% (54) of the total 2539 medico legal autopsies conducted during the study period. Most of the deaths (42.60%) occurred in the age group of 11-30 years and both males and females were affected in almost equal proportions. There was a marked increase in the number of cases in monsoon season (59.26%). The lower extremity was the most frequently involved site of bite (62.96%). Snakes were identified in 43 cases (79.63%) and among the identified cases the most common culprit was Viper amounting to 29.63% of cases followed by Krait causing 24.07% of the deaths. The findings in our study reflects the necessity of educating the rural community regarding the hazards of snake bite, importance of early medical attention and to avoid wasting vital time being engaged by traditional healers.
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Affiliation(s)
- Jamebaseer M Farooqui
- Department of Forensic Medicine & Toxicology, Rural Medical College of Pravara Institute of Medical Sciences, A/P Loni Bk, Tal. Rahata, Dist. Ahmednagar, Maharashtra 413736, India.
| | - Bimbisar B Mukherjee
- Department of Forensic Medicine & Toxicology, Rural Medical College of Pravara Institute of Medical Sciences, A/P Loni Bk, Tal. Rahata, Dist. Ahmednagar, Maharashtra 413736, India.
| | - Shiv Narayan M Manjhi
- Department of Forensic Medicine & Toxicology, Rural Medical College of Pravara Institute of Medical Sciences, A/P Loni Bk, Tal. Rahata, Dist. Ahmednagar, Maharashtra 413736, India.
| | - Anjum Ara J Farooqui
- Department of Oral Medicine & Radiology, Rural Dental College of Pravara Institute of Medical Sciences, A/P Loni Bk, Tal. Rahata, Dist. Ahmednagar, Maharashtra 413736, India.
| | - Sandesh Datir
- Department of Forensic Medicine & Toxicology, Dr D.Y. Patil Medical College, Hospital & Research Centre, Pune, Maharashtra, India.
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Monzavi SM, Salarian AA, Khoshdel AR, Dadpour B, Afshari R. Effectiveness of a clinical protocol implemented to standardize snakebite management in Iran: initial evaluation. Wilderness Environ Med 2015; 26:115-23. [PMID: 25698180 DOI: 10.1016/j.wem.2014.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 08/13/2014] [Accepted: 09/06/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study was designed to evaluate the effectiveness of a new protocol implemented to standardize snakebite management in Iran. METHODS In this study, 27 patients treated according to the new protocol in 2012 (P+) were compared with 22 patients treated according to the previous modality in the year before implementation of the protocol (P-) in Mashhad Medical Toxicology Centre (MTC). Demographic characteristics and treatment details of all patients were recorded prospectively. Envenomation severity of each victim was assessed according to snakebite severity score (SSS). RESULTS After implementation of the protocol, a smaller percentage of patients received antivenom (AV) therapy (78% vs 95%; P=.079). In spite of no significant difference in baseline severity of envenomation between the 2 groups (SSS [mean±SD], 34.8±18.1 vs 35.5±17.4; P=.801), the P+ group received significantly fewer AV vials (8.4±6.8 vs 12.1±5.6 vials; P=.042) and had a significantly shorter length of hospital stay (2.2±1.5 vs 3.2±1.8 days; P=.027). Moreover, smaller proportion of P+ patients experienced recurrence of venom-induced effects; however, the difference was not significant (18.5% vs 36%; P=.159). The reduction in use of antiallergy treatments to prevent or treat acute hypersensitivity reactions approached statistical significance (41% vs 68%; P=.051). These findings denote a reduction in AV use of approximately 4 vials and a reduction in hospital stay of 1 day for each patient, which translates to approximately $196/patient in healthcare cost savings. CONCLUSIONS Implementation of a snakebite management protocol at MTC reduced overall antivenom usage, use of antiallergy interventions, and length of hospital stay.
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Affiliation(s)
- Seyed Mostafa Monzavi
- AJA University of Medical Sciences, Tehran, Iran (Drs Monzavi, Salarian, and Khoshdel); Addiction Research Center, Department of Internal Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran (Drs Monzavi, Dadpour, and Afshari)
| | - Amir Ahmad Salarian
- AJA University of Medical Sciences, Tehran, Iran (Drs Monzavi, Salarian, and Khoshdel)
| | - Ali Reza Khoshdel
- AJA University of Medical Sciences, Tehran, Iran (Drs Monzavi, Salarian, and Khoshdel)
| | - Bita Dadpour
- Addiction Research Center, Department of Internal Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran (Drs Monzavi, Dadpour, and Afshari)
| | - Reza Afshari
- Addiction Research Center, Department of Internal Medicine, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran (Drs Monzavi, Dadpour, and Afshari).
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Al-Sadoon MK. Snake bite envenomation in Riyadh province of Saudi Arabia over the period (2005-2010). Saudi J Biol Sci 2015; 22:198-203. [PMID: 25737653 PMCID: PMC4336444 DOI: 10.1016/j.sjbs.2014.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 11/18/2022] Open
Abstract
The present investigation is a retrospective review of snake bites in Riyadh province over the period (2005-2010). A total of 1019 cases of bites admitted to the Ministry of Health medical centers in Riyadh province were analyzed on the basis of age, sex, time of bite and its site on the body, outcome of treatment, antiserum dose and type of snake. Bites occurred throughout the six years with the highest frequency in 2005 and least in 2006 where most of the bite cases were mild and all evolved to cure except four patients who died following the administration of antivenom during 24 h after snake bite. Most of the patients were males (81.7%) and the most attacked age was within the range of 11-30 years (51.5%). All the bites were mainly in the exposed limbs and the most frequently bitten anatomical regions were the lower limbs (427 cases, 41.9%), principally the feet. The study incriminates Cerastes cerastes gasperettii in most of the bites indicating it as the snake of medical importance in Riyadh province. Also, the study indicates low degree of threat in spite of high rate of snake bites as a result of the availability of the medical facilities and the antivenin use in medical centers in Riyadh province.
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Affiliation(s)
- Mohammed K. Al-Sadoon
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
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Thapar R, Darshan BB, Unnikrishnan B, Mithra P, Kumar N, Kulkarni V, Holla R, Kumar A, Kanchan T. Clinico-Epidemiological Profile of Snakebite Cases Admitted in a Tertiary Care Centre in South India: A 5 Years Study. Toxicol Int 2015; 22:66-70. [PMID: 26862263 PMCID: PMC4721179 DOI: 10.4103/0971-6580.172260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study was conducted to assess the clinic-epidemiological profile of snakebite cases admitted at a Tertiary Care Centre in South India. MATERIALS AND METHODS A record based retrospective study was carried out at Kasturbha Medical College affiliated hospitals in Mangalore. All the snakebite cases admitted to the hospitals from January 2007 to December 2011 were included in the study. Data were collected using a pretested semi-structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS version 11.5). The results are expressed as percentages. RESULTS The study included 198 cases of snakebite victims. The majority of the cases were males (68.2%). The mean age of the study population was 34.8 years. Maximum numbers of snakebite cases were reported during the month of September to December (47.9%). The peak time of snakebite was between 18.01 and 24.00 h which was reported in 40.5% of the cases. Lower extremities were the most common site of bite in more than three-fourth of the cases (80.9%). The most common symptoms were a pain (45.9%) and swelling (44.9%). The case fatality rate was observed to be 3.0%. CONCLUSION Snakebite still remains a major public health problem in this part of the world. Knowledge must be imparted regarding the prevention of snakebites through community health programs. Messages regarding prompt reporting of such cases and importance of effective treatment must be disseminated among people through mass media and role plays.
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Affiliation(s)
- Rekha Thapar
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - B B Darshan
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Nithin Kumar
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Vaman Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Ramesh Holla
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Avinash Kumar
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Tanuj Kanchan
- Department of Forensic Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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Dehghani R, Fathi B, Shahi MP, Jazayeri M. Ten years of snakebites in Iran. Toxicon 2014; 90:291-8. [DOI: 10.1016/j.toxicon.2014.08.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 11/28/2022]
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Karakus A, Ozkan M, Karcioglu M, Ozden R, Ustun I, Caliskan K, Gokce C, Sahan M. Diabetic foot due to anaphylactic shock: a case report. ARCHIVES OF TRAUMA RESEARCH 2014; 3:e17610. [PMID: 25147776 PMCID: PMC4139693 DOI: 10.5812/atr.17610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/08/2014] [Accepted: 05/24/2014] [Indexed: 11/16/2022]
Abstract
Introduction: Diabetic foot is a clinical disorder, which is commonly seen in patients with diabetes mellitus. It is also the major cause of below knee amputation in the world. There are many underlying causes such as neuropathic, ischemic, and infectious causes for diabetic foot. Local or systemic complications may develop after snake bite. Case Presentation: We reported a very rare case, involving a 78-year-old male admitted to the Emergency Department, who developed anaphylactic shock and diabetic foot after the snake bite. Conclusions: Reviewing the literature, this is the second reported case of snake bite associated with diabetic foot.
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Affiliation(s)
- Ali Karakus
- Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
- Corresponding author: Ali Karakus, Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey. Tel: +90-5052540433, Fax: +90-3262455654, E-mail:
| | - Mustafa Ozkan
- Department of Plastic Surgery, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Murat Karcioglu
- Department of Anesthesia, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Raif Ozden
- Department of Orthopedic Surgery, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Ihsan Ustun
- Department of Endocrinology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Koca Caliskan
- Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Cumali Gokce
- Department of Endocrinology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Mustafa Sahan
- Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
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Dehghani R, Mehrpour O, Shahi MP, Jazayeri M, Karrari P, Keyler D, Zamani N. Epidemiology of venomous and semi-venomous snakebites (Ophidia: Viperidae, Colubridae) in the Kashan city of the Isfahan province in Central Iran. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2014; 19:33-40. [PMID: 24672563 PMCID: PMC3963321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 11/11/2012] [Accepted: 01/01/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Information on the epidemiology of venomous snake species responsible for envenomation to humans in Iran has not been well documented. In the Kashan city, venomous snakebite remains a recurring medical problem. Information providing the correct identification of snake species responsible for envenomation in this geographic region would be useful to regional medical clinics and personnel for the effective and optimal management of the patients. MATERIALS AND METHODS In this cross-sectional study, all patient data was collected from Kashan city and its suburbs. The specific data relating to the taxonomic identification of snakes responsible for envenomation were evaluated. A general approach to the diagnosis and management of patients was also provided. Snakes responsible for bites were transported to a laboratory, where their taxonomic classification was confirmed based on key anatomical features and morphological characteristics. RESULTS A total of 46 snakes were examined. Of these, 37 (80%) were non-venomous species, and 9 (20%) were identified as venomous. Seven of the nine venomous snake species (78%) were of the family Viperidae, and two specimens (22%) were in the family Colubridae. Specifically, the viperid species were Macrovipera lebetina obtusa, Pseudocerastes persicus, Pseudocerastes fieldi, and Echis carinatus. The two colubrid species were Malpolon monspessulanus insignitus and Psammophis schkari. CONCLUSION Five different species of venomous snakes responsible for envenomation in the Kashan city region were confirmed. The viper, P. fieldi, was reported for the first time in the central part of Iran.
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Affiliation(s)
- Rouhullah Dehghani
- Department of Environmental Health, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Omid Mehrpour
- Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Science, Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran,Address for correspondence: Dr. Omid Mehrpour, Medical Toxicology and Drug Abuse Research Center, Pasdaran Avenue, Birjand University of Medical Sciences, Birjand, Iran. E-mail:
| | - Morteza Panjeh Shahi
- Health Center of Kashan University Medical Sciences and Health Services, Kashan, Iran
| | - Mehrdad Jazayeri
- Health Center of Kashan University Medical Sciences and Health Services, Kashan, Iran
| | - Parissa Karrari
- Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Science, Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Dan Keyler
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis Medical Research Foundation, Minneapolis, MN, United States
| | - Nasim Zamani
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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