Review on Preparation and Research of Prescriptions for Snake Bites in Fujian Province

The history of research and preparation of prescriptions for snake bites in Fujian Province was reviewed, and the process of incorporating snake doctors into the system and the gradual establishment of snake bite treatment system in Fujian were explored. The composition of several main snake bite preparations in Fujian was preliminarily compared and analyzed to provide reference for the research and development of similar new preparations at present.

Placental Abruption Following Snakebites Envenomation: A Case Report and Literature Review

Background: Snakebite envenomation in pregnancy is uncommon. It can lead to a poor outcome in both the mother and the fetus. We describe our approach to envenomation in pregnancy based on the currently available evidence. Case: We reported two case of snakebite in the third trimester of pregnancy having caused placental abruption with expelling a fresh still born baby and a live baby. In both cases, consumption coagulopathy occurred. managed by polyvalent anti-snake and blood transfusion. Their investigations became normal and they were discharged of hospitalization. Conclusion: Snakebite envenomation in pregnant is a maternal and fetal emergency. Treatment must be quick and well adapted.

Persistent fibrinogen deficiency after snake bite: A case report

BACKGROUND Venom-induced consumption coagulopathy(VICC)is characterized by coagulation dysfunction accompanied by decreased coagulation factor activity and fibrinogen(FBG)concentrations.We report a patient with VICC caused by snake bite who manifested persistent FBG deficiency without abnormal coagulation factor activity.This information may be helpful in diagnosing and treating VICC.CASE SUMMARY A 49-year-old man who had been bitten by a snake 13 h previously was admitted to the Emergency Department of our hospital with visible swelling of a finger and a bleeding puncture site.The provisional diagnosis was VICC,this being made based on persistent bleeding from the puncture site and subcutaneous hemorrhage.Laboratory evidence of coagulation abnormalities,including fibrinolysis,and findings on thromboelastography confirmed VICC.He had persistent afibrinogenemia requiring intravenous infusions of cryoprecipitate and fresh frozen plasma,together with continuous large doses of human FBG.After this treatment,the patient’s right upper limb swelling improved significantly and his subcutaneous hemorrhage resolved.All of his abnormal laboratory findings returned to normal by day 25.During 6 months’of follow-up,the patient had no further hemorrhagic events.CONCLUSION Hemorrhagic snake venom can result in coagulation dysfunction characterized by persistent FBG deficiency without abnormal coagulation factor activity.

Snakebite Epidemiology in Bangladesh—A National Community Based Health and Injury Survey

Insert Snakebite is a global public health issue, and in majority of cases it is undermined. Tropical and subtropical countries are most effected, Bangladesh being one of them. There is scarcity of countries’ epidemiological situation in relation to snakebite poisoning. This study has looked at the epidemiological status of snakebite poisoning from national representative survey findings. Methods: A nationwide cross-sectional survey was conducted in 12 randomly selected districts of Bangladesh in 2003. A total of 171,366 households were surveyed and information was collected from 819,429 populations by face to face interview. Multi-stage cluster sampling methods were used in this survey and covered urban, rural and slum populations. Results: Annually an estimated 15,372 (10.98/100,000) individuals were bitten by snakes and of them 1709 (1.22/100,000) died every year. Males were found to be most vulnerable with a risk of 1.51 times higher than female. Rural populations were also 10.54 times higher at risk than the populations living in the urban areas. Among the victims 94% were from the poor socio economic conditions. Around 43.9% of the incidences occurred during evening to midnight. Home was found the most common area for snake bite (33.6%), and the Leg was found to be the most common site for biting (63.1%). A total of 96.6% victims sought treatment, of them 61% sought immediate treatment from traditional healing methods. Conclusions: Present incidence of snakebite in Bangladesh has clearly shown that there is emerging public health needs for intervention that can reduce the mortality and burden of the disease in the country.

Synergistic effect of flavonoids combined with antivenom on neutralisation of Naja naja venom

Objective:To evaluate the neutralizing effects of flavonoids on snake venom toxicity by stand-alone and combinatorial approaches.Methods:Synthetic flavonoids were assessed,either individually or in combination with antivenom,for their neutralization of phospholipase A_(2)(PLA_(2)),protease,antioxidant(DPPH)assay and hemotoxic activity.Molecular docking studies were performed to understand possible binding of flavonoids with Naja naja venom PLA_(2).In vivo studies were carried out to confirm the neutralisation effects using a mouse model.Moreover,inhibition of PLA_(2) was monitored using combinatorial approaches.Results:Among the flavonoids used,quercetin and naringenin inhibited PLA_(2)(56%and 45%),protease(71%and 64%),DPPH scavenging(69.0%and 77.5%)and hemotoxic(70%)activities.Molecular docking studies indicated that the flavonoids bind to the substrate-binding site of PLA_(2)(Cys44 and Tyr63).In vivo studies showed a reduction in the venom toxicity level in the presence of naringenin.Additionally,combinatorial studies using the mixture of flavonoid and anti-venom revealed the possibility of synergistic effect(up to 32%enhancement)in neutralising the venom enzymes.Conclusions:These flavonoids can be used as additives for the treatment of snake bites,which may exert synergistic effects in combination with antivenom and decrease the post-therapeutic effects caused by excessive use of antivenom.

Snakebite Envenomation During a Third Trimester of Pregnancy: A Case Report

To editor:Snakebite envenomation(SBE)is a life-threatening disease that typically results from the injection of toxins following the bite of a venomous snake.It affects people in predominantly poor,rural communities in tropical and subtropical countries.About 50%–55%of all snakebites result in envenoming.1 Snakebite is a common neglected public health issue.In Burkina Faso,the snake species belong to six families,among which Elapidae and Viperidae are the most venomous.A retrospective study showed that the total number of snakebite cases recorded from 2010 to 2014 was 114126 with an average annual incidence of(136±9)bites per 100000 people.2 With over 20000 snake bites,of which nearly 15000 envenomations,treated in health facilities about 300 deaths reported every year.Woman is more frailty to envenomation with high risk of complication than other group of population.Snake bite induced coagulopathy is the most lifethreatening complication with poor maternal and perinatal outcome.3 Literature to guide management of this rare obstetric complication remains limited.We report a case of a 3 gravida of 36 weeks of gestation with snakebite who was succesfully managed.Written consent for the use of case presentation and figures,and consent for publication in print and electronically has been given by the patient.

Dynamic changes of serum protein in rats with acute intoxication of Chinese cobra snake venom by proteomic analysis

To elucidate the toxic mechanism of snake venom at the protein level,proteomics technol-ogy was applied to investigate the effect of venom on circulation in the mammalian body.Temporal proteomic analysis was performed to profile the dynamic changes in the sera of Sprague-Dawley rats administered with Chinese cobra venom or saline.Using 8-plex iTRAQ analysis,392 and 636 serum proteins were identified to be linearly upregulated or downre-gulated over time in the low-dose group and high-dose group,respectively.These proteins were mainly associated with the acute phase response pathway,complement system,and liver X receptor(LXR)/retinoid X receptor(RXR)and farnesoid X receptor(FXR)/RXR activation pathways.Compared with the low-dose group,the immune response and integrin pathways were inhibited in the high-dose group,although no obvious effect was observed.With con-sistently higher or lower expression in the high-dose group compared to the low-dose group throughout the whole process of venom poisoning,two proteins,Kininogen-1(KNG1)and orosomucoid 1(ORM1),which are involved in metabolism and immune response,occu-pied a core position in the pathway network and are considered venom dose-dependent biomarker candidates.

Hyperbaric oxygen therapy improves outcome of snake envenomation:tertiary center experience

Aim:Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities.These injuries often complicated by cellulitis,gangrene,regional lymphadenopathy,compartment syndrome,bleeding abnormalities,septicemia,hypotension,and disseminated intravascular coagulation,resulting in significant morbidity and mortality.The purpose of the study is to share our experience of hyperbaric oxygen(HBO)therapy in the management of snakebite injuries.Methods:All patients who were treated for snakebite injuries in our department between October 2012 and October 2013 were included in the study.Results:Out of a total 395 patients,174 patients treated with anti-snake venom with a mortality of 17 posttreatment.Forty-four out of the 174 patients was in the pediatric age group.Out of the patients referred to our department,23 presented with cellulitis,7 with compartment syndrome and 17 for the management of soft tissue cover over the extremities.Of the 47 patients,30 involved the lower extremity and rest involved the upper extremity.All patients were subjected to HBO therapy as an adjunct.Six patients required flap cover:cross finger flap(n=2),anterolateral thigh free tissue transfer(n=1),lateral supramalleolar flap(n=1),groin flap(n=1),and dorsal metacarpal artery flap(n=1).There was no need for fasciotomy among the patients who suffered impending compartment syndrome.Conclusion:HBO therapy may reduce the incidence of fasciotomy and increase the effectiveness of plastic surgical modalities if administered early and may be used as a useful adjunct in the management of snake envenomation injury.

Fatal intracranial bleedings in a viper bite:A case report

Viper bite envenomation represents a significant occupational hazard among agricultural workers in India.The viper bite envenomation is usually suspected when a patient presents with predominant local symptoms at the bitten site,including pain,swelling,and necrosis.Further,systemic findings such as diffuse intravascular coagulation,hypotension,and shock may alert physicians of viper bite envenomation rather than a neurotoxic snake bite.However,cerebral complications are rare in viper bites but may potentially fatal.Central nervous system involvement in a viper bite is either due to neurotoxins or hemorrhagins present in the venom,which may induce cerebral thrombosis,ischemia,infarction,and hemorrhage.Here we present a case of a previously healthy adult male who succumbed to extensive subarachnoid,intracerebral,and intraventricular hemorrhages involving bilateral cerebral hemispheres following viper snake bite envenomation.This report highlights the importance of anticipating cerebral complications in viper bite envenomation,a rare occurrence.It also emphasizes the need for early antisnake venom administration to prevent and control systemic envenomation and its complications.