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A considerable number of patients present to hospitals in Eswatini each year following bites by venomous snakes. Effectively diagnosing and treating patients with snakebite envenoming requires healthcare workers to have a variety of generic and snakebite-specific medical skills. In several countries, however, healthcare workers have been found to have limited skills in managing snakebite patients. We used the Delphi method to adapt the Hennessy-Hicks training needs analysis questionnaire to the context of snakebite envenoming and subsequently used the adapted questionnaire to assess the self-perceived training needs of 90 healthcare workers from ten hospitals in Eswatini. Two-thirds (63%) of participants were nursing staff and one third (34%) medical doctors. Overall, 74% of healthcare workers had previously received training on snakebite. Although a training need was reported for all skills included in the survey, the extent of the training need varied between different skills and groups of healthcare workers. The highest average training need was registered in the domains 'research and audit' and 'clinical tasks' with the latter accounting for nine of the ten skills with the highest training need. Nurses reported a higher training need than doctors, especially for clinical tasks. Receiving snakebite training before as well as after obtaining the primary qualification was associated with the lowest average training need, particularly in clinical skills. Ninety-three percent of interviewed healthcare workers would welcome more frequent training opportunities on the clinical management of snakebite patients. This newly developed snakebite training needs analysis tool can aid in adapting training initiatives to a dynamic and evolving healthcare workforce and it is designed to be transferrable to snakebite endemic settings worldwide. Author summary: Snakebite envenoming is a life-threatening emergency occurring predominantly in low-and middle-income countries in the Global South. Studies involving healthcare workers in snakebite-endemic countries have indicated that recognizing and appropriately treating snakebite envenoming can pose a challenge to healthcare staff. Reducing the deaths and disabilities caused by snakebite envenoming, however, will require a strengthened, competent and skilled healthcare workforce. In this study, a panel of international snakebite experts designed a questionnaire based on skills essential to the clinical care of patients with snakebite envenoming and which can be employed in any region around the world to assess the snakebite-specific training needs of healthcare workers. The questionnaire was subsequently used in a sample of healthcare workers in Eswatini, a country in which snakebite envenoming is a public health concern. The measured training needs differed according to the skill in question, participants' profession and the extent and context of previously received snakebite training. Healthcare workers who had attended specialized snakebite training in the past had a markedly reduced training need for clinical skills. This study provides a useful tool which can help tailor snakebite-specific clinical training initiatives to the needs of local and regional healthcare workers. [ABSTRACT FROM AUTHOR]

Snakebites are a significant health issue, especially in tropical and subtropical regions. Envenomation from snakebites is a clinical emergency requiring prompt treatment. Recently, a new species of blunt‐nosed viper, Macrovipera razii, was identified in central and southern Iran through morphological and molecular studies. This large, dangerous viper can deliver substantial amounts of venom. Following reports to the Faculty of Health at Shiraz University of Medical Science (SUMS), the identification of venomous snakes involved in envenomation cases in Fars province was undertaken. Approximately 20 snakes were captured and presented by locals, while others provided photos. Despite some information being photo‐based, the data highlighted the significant role of this viper in envenomation cases. Macrovipera razii is now recorded from 12 counties in Fars province. One incident involved a male bitten in Shiraz, and another case led to a male needing limb amputation. This study emphasizes the importance of this newly described viper in recent snakebite envenomations in the region and reviews its distribution within the Fars province. [ABSTRACT FROM AUTHOR]

Objective: To examine the occurrence of post-traumatic stress disorder among patients who have experienced venomous snakebites and investigate the factors contributing to it. The results provided insights for devising suitable nursing interventions. Methods: Between June 2022 and October 2023, a total of 128 snakebite patients from the Advanced Snakebite Rescue Center at a tertiary hospital in Guizhou Province were chosen as participants using convenience sampling. General Information Questionnaire, the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), the Social Support Rating Scale (SSRS), the Visual Analog Scale (VAS), the Simple Clinical Severity Assessment Scale, and the Swelling Severity Rating Scale (SSRS) were assessed at the time of admission, and Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C) at 1 month after. Results: The prevalence of post-traumatic stress disorder (PTSD) among patients bitten by venomous snakes was found to be 67.97%, with an average PTSD score of 44.26±13.53. Various factors including cultural background, psychological resilience, social support, pain intensity, severity of snakebite, and degree of swelling were identified as influencing PTSD in these patients (all P < 0.05). Conclusion: The incidence of PTSD was increased in individuals with venomous snakebites, particularly among those with lower literacy levels, reduced psychological resilience, limited access to social support, increased pain levels, severe snakebites, and significant swelling. Healthcare professionals should address PTSD in patients with snakebites and implement preventive interventions targeting these high-risk factors to mitigate the occurrence of PTSD in this patient population. [ABSTRACT FROM AUTHOR]

Venomous snakebites are critical medical emergency. Most fatalities resulted from respiratory failure attributable to abrupt neuromuscular paralysis. A 35‐year‐old male was treated for a snakebite on the dorsum of his right foot, which occurred seven hours prior to hospital admission during sleep. The patient exhibited symptoms of headache, myalgia, extremity weakness, and altered consciousness. No hemorrhagic or myotoxic symptoms were observed. He subsequently had respiratory failure, necessitating emergency bedside intubation with an Ambu bag, followed by treatment initiated in the district hospital and continued in the intensive care unit of a medical college hospital. Timely diagnosis, immediate transport to a medical facility, and rapid bedside intubation can save the lives of individuals experiencing respiratory failure due to venomous snake bites. [ABSTRACT FROM AUTHOR]

Background: Accidents caused by snakes constitute a serious public health problem in Latin America and worldwide. The situation in the Brazilian Amazon region is neglected, resulting in the highest incidence of cases per capita in the country. Furthermore, the distance from urban areas makes it difficult for the population to access timely and effective medical care, including antivenom treatment. The Brazilian Amazon is characterised by high ethnic and cultural diversity, yet it lacks robust epidemiological information that would allow for the development of surveillance and prevention policies. This study aimed to assess the epidemiological profile of individuals affected by snakebite accidents from 2007 to 2021 in a poorly studied region of the Brazilian Amazon. Methods: To assess the relationship between snakebite accidents, rainfall and river flood levels, cross‐correlation functions were employed. Data from the public healthcare system database was used for this analysis. Results: The results indicate that the study area experiences a snakebite rate 10 times greater than the Brazilian average and double that of other Amazonian regions. The most affected victims consist of adult males residing in rural areas, with snakebite accidents being more common during the rainy season. Viperid snakes were responsible for most bites, with the lower limbs being the most common location of injury. The data revealed a positive correlation between the number of snakebite accidents both rainfall and fluvial data. Conclusions: The accident peak coincides with the Brazil nut harvest season, a highly significant forest product for the economy of rural communities. Our data reinforces the need for public policies focused on environmental education and prevention, such as the use of boots and leg guards. These preventive measures have the potential to reduce the number of snakebites accidents by approximately 85%. [ABSTRACT FROM AUTHOR]

The North African mountain viper (Vipera monticola) is a medically relevant venomous snake distributed in Morocco, Algeria, and Tunisia. Three subspecies of V. monticola , exhibiting differences in morphotypes and dietary regimes, are currently recognised: V. m. monticola , V. m. atlantica , and V. m. saintgironsi. Through the application of snake venomics, we analysed the venoms of specimens of Moroccan origin belonging to each of the three subspecies. Snake venom metalloproteinases (svMP), snake venom serine proteases (svSP), C-type lectin and C-type lectin-related proteins (CTL), and phospholipases A 2 (PLA 2) were predominant, with PLA 2 being the most abundant toxin family overall. Disintegrins (DI) and cysteine-rich secretory proteins (CRISP) were exclusive to V. m. monticola and V. m. atlantica , while l -amino-acid oxidases (LAAO) were only found in V. m. saintgironsi. The differences detected in the venom profiles, as well as in presence/absence and relative abundances of toxin families, indicate the occurrence of intraspecific venom variation within V. monticola. The identified patterns of venom similarity between subspecies seem to align more with their phylogenetic relationships than with the reported differences in their feeding habits. [Display omitted] • First proteomics analysis of the medically relevant Vipera monticola venom. • Evident venom variation across the three subspecies. • Characteristic viperine toxin families are predominant: svMP, svSP, CTL, and PLA 2. • DI and CRISP unique to "dwarf" subspecies V. m. monticola and V. m. atlantica. • LAAO exclusive to larger V. m. saintgironsi. [ABSTRACT FROM AUTHOR]

Background: Snakes have always managed to grab human attention and have been an object of fear and veneration since historic civilizations. Snakes are found almost all over the world. Snakebite is a common medical emergency and an occupational hazard, more so in Tropical India, where farming is a major source of employment. Venomous snakes prevalent in India usually belongs to 3 families. Snakebite envenomation is a major public health concern in developing countries. Acute kidney injury (AKI) is an important cause of mortality in patients with vasculotoxic snake bite. In India, renal failure is mostly associated with Russell's Viper & E. Carinatus bites (13-32%). Several mechanisms including hemorrhage, hypertension, haemolysis, haemoglobinuria rhabdomyolysis and DIC as well as the direct effect of the venom have been incriminated in the pathogenesis of snakebite-related nephropathy. Hemodynamic alterations induced by cytokines & vasoactive mediators leading to renal ischemia are important in ARF's pathogenesis, leading to cortical & tubular lesions. Materials and Methods: After getting institutional ethical committee clearance, the study conducted over the body of the 51 deceased came for medicolegal autopsy fulfilling the inclusion and exclusion criteria and following complete enumeration method. Socio-Demography related data were gathered from the Police Inquest. After collection, data were analyzed by available statistical software. Results: Total 51 cases had been selected after following the inclusion and exclusion criteria out of which 29 were males and 22 were females. Incidence of snake bite was maximum during rainy season in the month of June, July, August with August having the highest number of victims (12, 23.6%). Maximum number of victims in the study group fall between the age range 41 to 50 years, Highest age is 73 years & the lowest being 08 years. Out of 51 cases, 30 patients were admitted in BMC&H, while the rest 21 were admitted in other health facilities. Most of the victims were treated at a primary centre before referral. No "Brought -Dead" cases due to venomous snake bite were encountered during study period. Highest number (20, 39.2%) of snakebite occurred between 6am to 12pm, more precisely between 6am to 6:30am, followed by those between 6pm to 12midnight (14, 27.5%). Least incident was in between midnight to 6am. Highest number of bite were in the lower limb (41, 80.5%), followed by upper limb (7, 13.7%). Conclusion: In spite of several limitations and time constraints, this current study tried to focus on some socio demographic profile of victims of fatal snake bite which later may be useful to deploy newer preventive measure. [ABSTRACT FROM AUTHOR]

Background: Snakebite remains a significant public health concern in many regions of Bangladesh, particularly in southern Chattogram. The Non communicable Disease Control (NCDC) program under DGHS has put tremendous efforts and motivation toward the healthcare provider at Upazilla level to treat cases of snakebite successfully. This study provides a comprehensive analysis of snakebite cases, focusing on the epidemiological patterns, clinical profiles and management observed at Lohagara Upazilla Health Complex. Method: Through a cross-sectional study, analysis of the records of past two years of admitted patients was done which elucidates the demographic characteristics, clinical presentations, and management outcomes of snakebite envenoming in the southern Chattogram community. Result: A total of 202 cases of snakebite were treated successfully, among which 63.9% were male (n=129) and 36.1% were female (n=73). The mean age was approximately 32 years (±17.40) and most were in the age group of 11-20 years (52, 25.74%). 26 (13%) cases developed local envenoming by green-pit viper bite, whereas 6 (2.9%) developed systemic envenoming with neurotoxicity alone and only 1 (0.5%) had features of both neurotoxicity and local swelling. The majority of cases had a short hospital stay, with 171 (84.7%) cases discharged after one day. Maximum patients (55.5%) reached the hospital within one hour of bite. In 53.46% of cases, the species of snakes could not be identified. Conclusion: These findings indicate the need for targeted public health interventions focusing on education and firstaid training, as well as improved pre-hospital care practices to better address snakebite incidents. [ABSTRACT FROM AUTHOR]

Snake bite envenoming is a public hazard often faced by the rural population in the tropical countries like India. A 59 year old man was brought for post mortem examination with alleged history of non venomous snake bite after which he collapsed within 2 minutes. Autopsy revealed fang marks over the dorsum of left hand middle finger, a few ante mortem injuries and no other significant findings. The cause of death in a venomous snake bite could be due to respiratory failure, shock or hemorrhage with fatal period ranging from a few hours to even days. Many people are terrified of snakes believing that bite by almost any species can cause rapid death. Sudden death after a snake bite may not be attributable to envenoming. We believe that the cause of death in this case was most likely a vaso - vagal attack in response to fear and pain of the snake bite that triggered cardiac arrest. Importance of history and correlation with the autopsy findings helped us in arriving at the cause of death. [ABSTRACT FROM AUTHOR]

Life-threatening medical issues can result from snakebite, and hence this is a public health concern. In many tropical and subtropical nations such as Kenya, where a wide variety of poisonous snakes are prevalent, diagnosis of snakebite in health facilities is imperative. Different antivenoms are needed to treat the venom of different snake species. Nonetheless, it might be difficult for medical professionals to identify the exact snake species that envenomated a patient due to the similarities of several snake envenomations' clinical symptoms. Therefore, the necessity for an assay or technique for identifying venomous species is critical. The current study sought to develop a sensitive ELISA prototype for the detection of D. polylepis venom in Kenya using generated chicken-based IgY polyclonal antibodies. Serum samples containing specific chicken-based IgY antibodies previously raised against D. polylepis venom toxins were used in the assay development. ELISA parameters were optimized, and the developed assay was assessed for applicability. The limit of detection (LoD) of the ELISA for neurotoxic venoms was determined to be 0.01 µg/mL. Successful discrimination between neurotoxic and cytotoxic venoms was achieved by the ensuing inhibition ELISA assay. The developed assay showed the capability of identifying venoms in blood samples (from spiked and venom-challenged blood samples) of BALB/c mice, providing compelling evidence of the strategy's usefulness. This assay could help physicians diagnose and manage victims of snakebites through the evaluation of clinical samples. [ABSTRACT FROM AUTHOR]

Snakebite envenomation remains an important, yet a neglected public health issue in most tropical and subtropical countries. Underdeveloped medical infrastructure, suboptimal medical services, poor documentation and failure to make snake-related injury a mandatory notifiable disease are important contributing factors. The King Cobra (Ophiophagus hannah) is a medically significant species encountered in Malaysia however, there have been few publications from the clinical perspective. The objectives of this study were to determine the frequency of King Cobra related injuries, geographical distribution, clinical presentation, type and frequency of antivenom utilization and the management outcome. This is a cross-sectional study of confirmed King Cobra related injuries consulted to Remote Envenomation Consultation Services (RECS) from 2015 to 2020. Data were extracted from the RECS database and descriptively analyzed. A total of 32 cases of King Cobra bite were identified. Most cases were from Peninsular Malaysia with the most frequent from the state of Pahang (n = 9, 28.1%). Most patients got bitten while attempting to catch or play with the snake (68.8%). Signs and symptoms of envenomation were documented in 24 (75.0%) cases and the most frequent systemic manifestation was ptosis (n = 13, 40.6%). Tracheal intubation and ventilatory support were required in 13 (40.6%) patients. Antivenom was administered to 22 (68.8%) patients with most (25.0%) receiving 10 vials (1 dose). The commonest antivenom used was monospecific King Cobra antivenom (50.0%) from Thai Red Cross. There was one death documented due to complications from necrotizing fasciitis and septicemia. Public awareness of the dangers and proper handling of King Cobras needs to be emphasised. Timely administration of the appropriate antivenom is the definitive treatment and leads to favorable outcomes. Author summary: King Cobra is the longest venomous snake in the world and is widely distributed in Peninsular and East Malaysia. There is lack of documentation and publication of King Cobra bite injuries in Malaysia. This may lead to poor awareness of the significance and the severity of envenomation from this species. There are two types of antivenom used in Malaysia for treating King Cobra envenomation, namely Queen Saovabha Memorial Institute (QSMI), Thai Red Cross King Cobra antivenom and QSMI neuropolyvalent antivenom. There were no previous publications on the clinical outcomes of the utilisation of these antivenom for King Cobra envenomation in Malaysia. This study analysed confirmed King Cobra bite injuries consulted to Remote Envenomation Consultancy Services (RECS) from 2015–2020. The RECS consultation log was analysed for the frequency, geographical distribution, clinical features, management and outcome. This study provides verified and reliable information that can be used in the future for developing health policy and clinical management guidelines. [ABSTRACT FROM AUTHOR]

Access to antivenoms in cases of snakebite continues to be an important public health issue around the world, especially in rural areas with poorly developed health care systems. This study aims to evaluate therapeutic itineraries and antivenom accessibility following snakebites in the states of Oaxaca and Chiapas in southern Mexico. Employing an intercultural health approach that seeks to understand and bridge allopathic and traditional medical perceptions and practices, we conducted field interviews with 47 snakebite victims, documenting the therapeutic itineraries of 54 separate snakebite incidents that occurred between 1977 and 2023. Most victims used traditional remedies as a first line of treatment, often to withstand the rigors of a long journey to find antivenoms. The main obstacles to antivenom access were distance, poor antivenom availability, and cost. Standard antivenom treatment is highly valued and sought after, even as traditional beliefs and practices persist within a cultural framework known as the "hot-cold" system. The findings are crucial for informing future enhancements to antivenom distribution systems, health education initiatives, and other interventions aimed at mitigating the impact of snakebites in the region. Author summary: Every year, hundreds of thousands of people worldwide are killed, disabled, or disfigured by bites from venomous snakes. Snakebite is especially dangerous in rural areas of the global south, where victims often must travel long distances to clinics or hospitals to receive antivenom treatment. What sorts of obstacles do snakebite victims face in their search for antivenom? And why do people choose traditional remedies, such as homeopathic treatments, even though these have limited evidence of effectiveness against snakebite envenoming? To answer these questions, we conducted field research in rural areas of Oaxaca and Chiapas states in southern Mexico in 2023, including interviews with 47 snakebite victims. In line with other studies, we found that the main obstacles to antivenom access are distance, cost, and scarcity of antivenom supply. And by listening more closely to victims' accounts of their therapeutic itineraries, we have a better understanding of why people might choose traditional remedies for snakebite. These reasons include long-established cultural frameworks about the causes of illness and the need to alleviate pain to withstand the long journey to conventional treatment. By taking an intercultural approach, which emphasizes mutual respect and understanding between Western and indigenous health belief systems, we can improve access to antivenom, health education initiatives, and other interventions aimed at mitigating the impact of snakebites in Mexico and beyond. [ABSTRACT FROM AUTHOR]

Introduction: Local tissue destruction following envenomation from North American snakes, particularly those within the Crotalinae subfamily, has the potential to progress to compartment syndrome. The pathophysiology of venom-induced compartment syndrome (VICS) is a debated topic and is distinct from trauma/reperfusion-induced compartment syndrome. Heterogeneity exists in the treatment practices of VICS, particularly regarding the decision to progress to fasciotomy. Associations with functional outcomes and evolution in clinical practice since the introduction of Crotalidae polyvalent immune Fab (FabAV) have not been well defined. Our goal was to identify the potential gaps in the literature regarding this phenomenon, as well as illuminate salient themes in the clinical characteristics and treatment practices of VICS. Methods: We conducted this systematic scoping-style review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Records were included if they contained data surrounding the envenomation and hospital course of one or more patients who were envenomated by a snake species native to North America and were diagnosed with compartment syndrome from 1980-2020. Results: We included 19 papers: 10 single- or two-patient case reports encompassing 12 patients, and nine chart reviews providing summary statistics of the included patients. In case reports, the median compartment pressure when reported was 60 millimeters of mercury (interquartile range 55-68), 66% underwent fasciotomy, and functional outcomes varied. Use of antivenom appeared to be more liberal with FabAV than the earlier antivenin Crotalidae polyvalent. Rapid progression of swelling was the most commonly reported symptom. Among the included retrospective chart reviews, important data such as compartment pressures, consistent laboratory values, and snake species was inconsistently reported. Conclusions: Venom-induced compartment syndrome is relatively rare. Existing papers generally describe good outcomes even in the absence of surgical management. Significant gaps in the literature regarding antivenom dosing practices, serial compartment pressure measurements, and functional outcomes highlight the need for prospective studies and consistent standardized reporting. [ABSTRACT FROM AUTHOR]

Background: Russell’s viper is one of the most venomous snakes found in Bangladesh. Acute kidney injury (AKI) is a devastating complication of viper bite causing significant morbidity and mortality. We report a case of Russell’s viper bite who presented with venom-induced consumption coagulopathy (VICC), thrombotic microangiopathy (TMA) and rhabdomyolysis. He was treated with antivenom and repeated hemodialysis and subsequently discharged. Case presentation: A 60-year-old farmer presented with history of Russell’s viper bite with local swelling without neurological involvement. His 20-minute whole blood clotting test was positive. After initial assessment, polyvalent antivenom was administered. Subsequently, he developed AKI, anasarca, high blood pressure (210/110mmHg), moderate anemia, edema (+++), bilateral crepitation at both lung fields. His blood report was suggestive of DIC, rhabdomyolysis and AKI. He was treated with blood transfusion and repeated haemodialysis. Renal biopsy revealed renal cortical necrosis with thrombotic microangiopathy. After 3 weeks of repeated hemodialysis, his condition improved and finally discharged. Discussion: Russell’s viper causes coagulopathy, nephrotoxicity, neurotoxicity, myotoxicity and cardiotoxicity. It causes VICC leading to occlusion of small and large vessels. AKI may result from hypovolemic shock, rhabdomyolysis and acute tubular necrosis that results secondary to VICC. Our patient had local swelling, coagulation abnormality, thrombocytopenia, high CPK, high LDH, schistocytes, high D-dimer, raised indirect bilirubin and raised serum creatinine confirmed the presence of VICC, TMA and rhabdomyolysis. The findings of microangiopathic hemolytic anemia, thrombocytopenia and cortical necrosis strongly suggest DIC as the culprit for the renal lesions in the patient. Although DIC with marked thrombocytopenia had a high mortality, our patient got antivenom and hemodialysis early for which he survived. Conclusion: TMA, cortical necrosis and rhabdomyolysis causing AKI are some of the rare but lethal complications following Russell’s viper bite. Prompt treatment with antivenom, haemodialysis and other supportive management is essential to save the life of the patient. [ABSTRACT FROM AUTHOR]

The genus Vipera encompasses most species of medically significant venomous snakes of Europe, with Italy harbouring four of them. Envenomation by European vipers can result in severe consequences, but underreporting and the absence of standardised clinical protocols hinder effective snakebite management. This study provides an updated, detailed set of guidelines for the management and treatment of Vipera snakebite tailored for Italian clinicians. It includes taxonomic keys for snake identification, insights into viper venom composition, and recommendations for clinical management. Emphasis is placed on quick and reliable identification of medically relevant snake species, along with appropriate first aid measures. Criteria for antivenom administration are outlined, as well as indications on managing potential side effects. While the protocol is specific to Italy, its methodology can potentially be adapted for other European countries, depending on local resources. The promotion of comprehensive data collection and collaboration among Poison Control Centres is advocated to optimise envenomation management protocols and improve the reporting of epidemiological data concerning snakebite at the country level. [ABSTRACT FROM AUTHOR]

Background: Photobiomodulation has exhibited promise in mitigating the local effects induced by Bothrops snakebite envenoming; however, the mechanisms underlying this protection are not yet fully understood. Herein, the effectiveness of photobiomodulation effects on regenerative response of C2C12 myoblast cells following exposure to Bothrops jararacussu venom (BjsuV), as well as the mechanisms involved was investigated. Methodology/Principal findings: C2C12 myoblast cells were exposed to BjsuV (12.5 μg/mL) and irradiated once for 10 seconds with laser light of 660 nm (14.08 mW; 0.04 cm2; 352 mW/cm2) or 780 nm (17.6 mW; 0.04 cm2; 440 mW/ cm2) to provide energy densities of 3.52 and 4.4 J/cm2, and total energies of 0.1408 and 0.176 J, respectively. Cell migration was assessed through a wound-healing assay. The expression of MAPK p38-α, NF-Кβ, Myf5, Pax-7, MyoD, and myogenin proteins were assessed by western blotting analysis. In addition, interleukin IL1-β, IL-6, TNF-alfa and IL-10 levels were measured in the supernatant by ELISA. The PBM applied to C2C12 cells exposed to BjsuV promoted cell migration, increase the expression of myogenic factors (Pax7, MyF5, MyoD and myogenin), reduced the levels of proinflammatory cytokines, IL1-β, IL-6, TNF-alfa, and increased the levels of anti-inflammatory cytokine IL-10. In addition, PBM downregulates the expression of NF-kB, and had no effect on p38 MAKP. Conclusion/Significance: These data demonstrated that protection of the muscle cell by PBM seems to be related to the increase of myogenic factors as well as the modulation of inflammatory mediators. PBM therapy may offer a new therapeutic strategy to address the local effects of snakebite envenoming by promoting muscle regeneration and reducing the inflammatory process. Author summary: Photobiomodulation (PBM) therapy, a technique using light to influence cell behavior, has shown promising results in reducing the damage caused by snakebites from Bothrops species, a common venomous snake in Latin America. This study explores how PBM aids in the recovery of muscle cells after exposure to Bothrops jararacussu venom. Our research focused on C2C12 myoblast cells, a type of muscle cell, treated with PBM following venom exposure. We observed that PBM not only helped these cells move and close wounds faster but also increased the production of proteins essential for muscle formation and recovery. Interestingly, it also shifted the balance towards less inflammation by decreasing pro-inflammatory signals and increasing anti-inflammatory ones. This work sheds light on the potential of PBM as a novel treatment approach for snakebite victims. By promoting muscle repair and reducing inflammation, PBM therapy could improve recovery outcomes following envenoming. Our findings suggest that, with further development, PBM could become a valuable tool in the medical response to snakebites, offering a ray of hope for faster, more effective recovery processes. [ABSTRACT FROM AUTHOR]

Every year, according to the World Health Organization, nearly 5,000,000 million accidents due to snake bites are reported worldwide, of which it is estimated that 33.3% to 50% of cases present as poisoning. Ophidic accidents that include ophidiotoxicosis have care protocols of therapy with antivenom serums, which vary according to the genus and species of the snake. Although in Colombia there are protocols for the care of ophidiotoxicosis in humans described by health entities, the canine clinic lacks this information. The aim of this systematic review is to build a medical protocol for ophidiotoxicosis in canines based on information reported in Colombia or tropical countries with which similar venomous snakes are shared. For this action, the PRISMA protocol was used; in total, 57 articles and 10 official documents on protocols for the care of ophidic accidents in humans were reviewed, which allowed the possible to classify snakebite accidents in group 1 (Bothrops, Lachesis and Crotalus accidents) and group 2 (Micrurus accident), also establish a medical protocol for ophidiotoxicosis in each of the groups indicated in canines, depending on the severity of the clinical and paraclinical condition. In conclusion, the clinical and paraclinical signs of the canine, vasculotoxic or neurotoxic, allow us to identify the group to which the aggressor snake belongs (group 1 or group 2, respectively), and their severity guides the selection and dosage of antivenom therapy specific for the clinical management of ophidiotoxicosis in canines. [ABSTRACT FROM AUTHOR]

We tested the effects of relational and instrumental message strategies on US residents' perception of rattlesnakes—animals that tend to generate feelings of fear, disgust, or hatred but are nevertheless key members of healthy ecosystems. We deployed an online survey to social media users (n = 1,182) to describe perceptions of rattlesnakes and assess the change after viewing a randomly selected relational or instrumental video message. An 8–item, pre–and post–Rattlesnake Perception Test (RPT) evaluated perception variables along emotional, knowledge, and behavioral gradients on a 5–point Likert scale; the eight responses were combined to produce an Aggregate Rattlesnake Perception (ARP) score for each participant. We found that people from Abrahamic religions (i.e., Christianity, Judaism, Islam) and those identifying as female were associated with low initial perceptions of rattlesnakes, whereas agnostics and individuals residing in the Midwest region and in rural residential areas had relatively favorable perceptions. Overall, both videos produced positive changes in rattlesnake perception, although the instrumental video message led to a greater increase in ARP than the relational message. The relational message was associated with significant increases in ARP only among females, agnostics, Baby Boomers (age 57–75), and Generation–Z (age 18–25 to exclude minors). The instrumental video message was associated with significant increases in ARP, and this result varied by religious group. ARP changed less in those reporting prior experience with a venomous snake bite (to them, a friend, or a pet) than in those with no such experience. Our data suggest that relational and instrumental message strategies can improve people's perceptions of unpopular and potentially dangerous wildlife, but their effectiveness may vary by gender, age, religious beliefs, and experience. These results can be used to hone and personalize communication strategies to improve perceptions of unpopular wildlife species. [ABSTRACT FROM AUTHOR]

Background: Snakebites are a dangerous and significant medical emergency that occurs worldwide. The World Health Organization has recommended that teaching and training in the prevention and management of snakebites be included in the curriculum of nursing schools and other educational activities. Identification of venomous snakes and first aid would be more critical in the prevention of occupational danger worldwide. This study aims to assess the knowledge in identifying venomous snakes, snakebites, and first aid methods of snakebites among nursing students in the Southern Province of Sri Lanka. Methods: A descriptive, cross-sectional study was performed among 425 nursing students who were studying in different educational settings: undergraduates at the University of Ruhuna, and nursing students in the three schools of nursing in Galle, Matara, and Hambantota. Data were gathered by incorporating a pre-tested self-administered questionnaire after obtaining institutional permission. The total score of whole knowledge ranged from 0 to 34 for the identification of venomous snakes. Data collection was performed after obtaining ethical clearance from the Ethics Review Committee, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka. Results: Most of the students (82.6%) were in the 24–26 age category and the majority were females. Most of the sample (64.7%) had low knowledge of identifying venomous snakes. A higher percentage of students (57.4%) had a sufficient level of knowledge about first aid methods associated with snakebites and 169 participants (39.8%) had a high level of knowledge regarding first aid methods. Further, a significant impact on students' knowledge and knowledge of first aid methods was reported. Conclusion and recommendation: The overall knowledge of identifying venomous snakes among the nursing students was inadequate. However, the knowledge about the first aid methods was at a moderate level. Strategies are needed to improve knowledge in identifying venomous snakes and first aid methods of snakebites amongst nursing students in both educational settings. [ABSTRACT FROM AUTHOR]

Snakebite is a serious injury and a common reason for the increasing death rate. Thus, it should be treated and assessed as highly prior, even in cases that seem well. The paper presents a retrospective investigation of snakebites in Iraq from 2019 to 2021 conveyed by the General Administration of Statistics and Information, Ministry of Health, Republic of Iraq. After obtaining the institutional committee's approval, the authors performed the extraction, analysis, and reporting of the data. A total number of 802 patients were informed throughout three years, with the highest percentage in males (63%). The maximum rate of snake envenomation (P < 0.05) was documented in (41.64%). The highest percentage of anti-venom injections administered in 2021 was 57% (n = 1118). Snakebite cases were mainly reported during June and July in al Yarmouk Hospital, with a total of 17.36% (n = 50) and 17.46% (n = 52), respectively. In Murjan Hospital, the months were September and August with a total of 50% (n = 8) and 40.35% (n = 7), respectively. In Baqubah Hospital, the months were May and August, with a total of 17.3% (n = 52) and 16.8% (n = 50), respectively. Finally, in the Al Hussein Hospital, the months were July and September, with a total of 23.5% (n = 43) and 22.2% (n = 39), respectively. Only 10 cases out of 802 died. The incidence of snakebites showed an increasing trend during the study period, and the incidence mostly occurred in July, August, and September. [ABSTRACT FROM AUTHOR]

Background: Snakebite is an important occupational hazard in India as it is always been a land of poisonous snakes. The isssue which the physician confronts while treating a snake bite patient is assesment of degree of envenomation and requirement of ASV dose. Aims and Objectives: This study was taken to evaluate the optimum dose of anti-snake venom (ASV) required based on the severity of envenomation. Materials and Methods: Patients with a history of snakebite brought to the Department of General Medicine, Hassan, were included in this study. The study was conducted during the period from December 2014 to June 2016. The sample size of 80 patients was included in the study after fulfilling the inclusion criteria. Results: A total of 80 patients were included in the study. The majority of the victims were males (70%), age between 21 and 40 years (47.5%), and agriculture was the main occupation (67.3%). 51.25% did not identify the snake. The most poisonous were viper and cobra types which were 36.5% and 12.5%, respectively. A delay in lag time of 8.99±8.2 h was observed in severe envenomation. Overall, 51 cases (63.75%) had cellulitis, and 3 (3.75%) in the severe group required fasciotomy. Twenty percent had hematologic derangements. Ten percent of patients had developed renal failure and one required dialysis. 8.75% of patients developed respiratory failure and all required mechanical ventilation. The average dose of ASV vials used in mild, moderate, and severe envenomation was 9.04±3.51 vials, 18.5±5.27 vials, and 28.6±7.30 vials, respectively. The overall mortality rate was 5%. Conclusions: The optimum dose of ASV required in mild, moderate, and severe envenomation is 9.04±3.51 vials, 18.5±5.27 vials, and 28.6±7.30 vials, respectively to neutralize the circulating venom and lower the risk of development of serious complications. [ABSTRACT FROM AUTHOR]

Negative interactions between humans and venomous snakes are increasing, with the World Health Organization committed to halving snakebite deaths and disabilities by 2030. Evidence‐based strategies are thus urgently required to reduce snakebite events in high‐risk areas, while promoting snake conservation. Understanding the factors that drive the adoption of snakebite prevention measures is critical for the effective implementation of snakebite management strategies. We conducted in‐person questionnaires (n = 535 respondents) with rural agricultural communities within the Thiruvarur District of Tamil Nadu, India, a national snakebite hotspot. Using a health belief model framework, we explored current snakebite prevention measures and factors impacting their adoption. The majority of respondents reported using multiple snakebite prevention measures. Perceived self‐efficacy and perceived risk frequency of snakebites were important overall predictors of future adoption, whereas education, gender, relative wealth, and current adoption were important for specific measures. Achieving international commitments to support human–snake coexistence will require collective and collaborative action (e.g., governments, donor agencies, civil society organizations, researchers, and communities) underpinned by behavioural insights and context‐specific solutions. [ABSTRACT FROM AUTHOR]

Introduction: Snakebites pose a significant public health challenge globally, with India hosting over 250 venomous snake species. This study focuses on four major venomous land snakes, including the saw-scaled viper, responsible for numerous incidents worldwide. Snakebites result in millions of cases annually, with India reporting a substantial number, though the actual incidence and mortality rates may be underestimated due to traditional treatments in rural areas. Objective: The research aims to evaluate clinical parameters in patients with poisonous snakebites, emphasizing clinical predictors of mortality. Methodology: Conducted at a Medical College and Hospital from January to November 2023, the study involved 432 snakebite patients, with 260 exhibiting envenomation signs. Clinical criteria and treatments were standardized, and patient outcomes were monitored. Statistical analysis utilized SPSS version 26.0. Results: Among 260 patients, 58 did not survive, resulting in a mortality rate of 22.3%. No significant age or gender differences were observed between survivors and non-survivors. Rural areas accounted for a higher incidence, and September had the peak admission of patients. Lower limbs were predominantly affected (75.8%). Local pain and swelling were common symptoms. Bleeding tendencies, respiratory failure, and shock were associated with higher mortality. Discussion: Mortality rates varied, and factors like delayed hospital arrival, respiratory failure, acute renal failure, severe coagulopathy, and shock were identified as contributors to death. The study highlighted the correlation between mortality and complications such as bleeding tendencies and respiratory failure. Conclusion: The study concludes that predicting mortality in snakebite patients is feasible using straightforward variables like bleeding tendencies, respiratory failure, and shock. These findings can aid healthcare practitioners in directing high-risk cases to advanced facilities promptly. Availability of Anti-snake venom at Primary Health Centers and raising awareness about prompt hospitalization can improve outcomes. [ABSTRACT FROM AUTHOR]

Improved therapies are needed against snakebite envenoming, which kills and permanently disables thousands of people each year. Recently developed neutralizing monoclonal antibodies against several snake toxins have shown promise in preclinical rodent models. Here, we use phage display technology to discover a human monoclonal antibody and show that this antibody causes antibody-dependent enhancement of toxicity (ADET) of myotoxin II from the venomous pit viper, Bothrops asper, in a mouse model of envenoming that mimics a snakebite. While clinical ADET related to snake venom has not yet been reported in humans, this report of ADET of a toxin from the animal kingdom highlights the necessity of assessing even well-known antibody formats in representative preclinical models to evaluate their therapeutic utility against toxins or venoms. This is essential to avoid potential deleterious effects as exemplified in the present study. The recent emergence of monoclonal antibodies able to neutralize snake toxins have revolutionized the approach of developing novel therapies to treat snakebite envenoming, at least in animal models. Here, the authors show antibody-dependent enhancement of toxicity (ADET) for a toxin derived from snake venom and highlight the importance of this phenomenon when testing therapeutic antibodies against snake venoms in animal models. [ABSTRACT FROM AUTHOR]

Snake envenoming is a major, but neglected, tropical disease. Among venomous snakes, those inducing neurotoxicity such as kraits (Bungarus genus) cause a potentially lethal peripheral neuroparalysis with respiratory deficit in a large number of people each year. In order to prevent the development of a deadly respiratory paralysis, hospitalization with pulmonary ventilation and use of antivenoms are the primary therapies currently employed. However, hospitals are frequently out of reach for envenomated patients and there is a general consensus that additional, non-expensive treatments, deliverable even long after the snake bite, are needed. Traumatic or toxic degenerations of peripheral motor neurons cause a neuroparalysis that activates a pro-regenerative intercellular signaling program taking place at the neuromuscular junction (NMJ). We recently reported that the intercellular signaling axis melatonin-melatonin receptor 1 (MT1) plays a major role in the recovery of function of the NMJs after degeneration of motor axon terminals caused by massive Ca2+ influx. Here we show that the small chemical MT1 agonists: Ramelteon and Agomelatine, already licensed for the treatment of insomnia and depression, respectively, are strong promoters of the neuroregeneration after paralysis induced by krait venoms in mice, which is also Ca2+ mediated. The venom from a Bungarus species representative of the large class of neurotoxic snakes (including taipans, coral snakes, some Alpine vipers in addition to other kraits) was chosen. The functional recovery of the NMJ was demonstrated using electrophysiological, imaging and lung ventilation detection methods. According to the present results, we propose that Ramelteon and Agomelatine should be tested in human patients bitten by neurotoxic snakes acting presynaptically to promote their recovery of health. Noticeably, these drugs are commercially available, safe, non-expensive, have a long bench life and can be administered long after a snakebite even in places far away from health facilities. Author summary: Snakebite envenomings cause important tropical human diseases that often include a lethal muscle paralysis. Current treatments consist in hospitalization and antivenoms, which are not always quickly accessible to victims. In fact, these snakebites take place mainly in rural and low-income countries. In this work, researchers discovered, in mice, a novel function of melatonin and of its type 1 receptor in promoting functional recovery after snake-induced peripheral neuroparalysis with nerve terminal degeneration. In particular, researchers found that drugs approved for the treatment of insomnia (Ramelteon) and depression (Agomelatine), activate melatonin receptor and promote the functional recovery after a krait venom induced paralysis. These drugs are on sell in pharmacies, are safe and stable, and are ready to be tried for promoting the recovery from peripheral neuroparalysis in human victims bitten by neurotoxic snakes, even without hospitalization. [ABSTRACT FROM AUTHOR]

Venomous snakebite is a neglected tropical disease and disease of poverty, affecting hundreds of thousands of people annually. The only effective medical intervention for snakebite is antivenom, produced primarily using captive venomous snakes as a source of venom. This paper analyzes snakes' welfare at venom labs within this global health context. I recommend significant changes to improve the welfare of captive snakes, particularly in light of recent ethological research and attention on snakes. These recommendations are broadly consequentialist, aiming to improve the lives of the snakes and ensure that people have increased access to affordable antivenom. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Snakebite is a significant global public health concern. Venomous snake bites can lead to various life‐threatening clinical conditions that affect different bodily systems. These include the nervous system (neurotoxicity), musculoskeletal system (myotoxicity), cardiovascular system (cardiotoxicity), and blood clotting mechanisms (haemotoxicity). Here, we report a 5‐year‐old boy who was bitten by a snake and presented to the Emergency department with complaints of significant infection, necrosis, and gangrene affecting the three fingers of his right hand. After clinical evaluation and investigations, the patient underwent surgical intervention. The patient was discharged from the hospital after 5 weeks of admission with advice to follow up with a primary care physician and physical rehabilitation therapy to ensure the optimal healing and functionality of the affected hand. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the extent of knowledge among emergency residents (ERs) regarding the identification of common local venomous snakes and the management of snakebites and to identify predictive factors influencing the adequacy of this knowledge. METHODOLOGY: This study conducted a self-developed, questionnaire-based, anonymous, and selfadministered cross-sectional survey from March to June 2018 at two major urban hospitals in Malaysia's Klang Valley region: the Emergency Department (ED) of University Malaya Medical Centre (UMMC) and the ED of Hospital Tengku Ampuan Rahimah (HTAR). A structured questionnaire covering demographic information, snakebite recognition, and management was distributed to ERs. We employed a nonprobability, purposive universal sampling method. We randomly selected samples from a list provided by the person in charge. RESULTS: Only 16.3% demonstrated adequate knowledge in this domain. Univariate logistic regression analysis indicated a significant association between age and knowledge adequacy (p<0.05) and a marginal association between knowledge adequacy and gender (p=0.046) or prior snakebite training (p=0.05). Subsequent backward stepwise logistic regression analysis identified age as the sole significant independent predictor, accounting for gender, work experience, position, training received, and management experience (p=0.012; OR 1.33, 95% CI 1.07-1.67). CONCLUSION: the study revealed a deficiency in knowledge regarding snakebite recognition and management among emergency residents. Advanced age is a predictor of knowledge adequacy in snakebite management. Therefore, implementing an improved educational program targeting healthcare professionals across all levels and categories is a viable and practical solution. [ABSTRACT FROM AUTHOR]

Snakebite is a medical emergency. It can cause local and systemic effects in humans. Different venomous snakes produce different types of venom, which can cause a variety of symptoms and complications. The scarcity of antisnake venom serum (SABU) in Indonesia encourages alternative administration strategies to patients, namely suboptimal doses or subdose. Three cases of adult patients with a history of snakebite and diagnosed with snakebite grade III were reported. The patient underwent initial antivenom therapy using suboptimal doses of anti-snake venom serum (SABU) due to the scarcity of SABU and fresh frozen plasma (FFP) and thrombocyte concentrate (TC) transfusions as well as initial emergency management and routine blood tests and coagulation function. Evaluation was done daily of clinical improvement and coagulation function. This case series proves that administration of suboptimal antivenom therapy, when combined with additional FFP and TC transfusions, coupled with appropriate supportive care and patient monitoring can result in good outcome in patients. [ABSTRACT FROM AUTHOR]

We aimed to determine the epidemiology and clinical management of patients presenting to an Australian tertiary emergency department (ED) with a suspected snake bite. Nepean Hospital covers a geographical area known to harbour venomous elapid snake species. A Retrospective chart review of all patients presenting to Nepean ED from 2011 to 2020 was performed. We searched the electronic medical records (eMR) for triage presentations including search terms of "snakebite", "bite" "envenomation", or "bite-snake" and a discharge or independent diagnosis of "snakebite" or "envenomation". Our review identified 110 patients presenting with snakebite, of whom nine had signs or symptoms indicating envenomation. The most common envenomation syndrome was venom-induced consumption coagulopathy (VICC) and the most commonly suspected culprit snake was the Eastern Brown Snake. Our data broadly agreed with national data on epidemiology and demographics. We noted a satisfactory rate of compliance with local snake bite protocols with evidence of early diagnosis and antivenom administration. We had no cases of anaphylaxis and one case of serum sickness. Our study of a tertiary hospital experience in the management of snake bite demonstrated an appropriate adherence to national guidelines and early clinician recognition of envenomation syndromes. It also demonstrated appropriate antivenom use without obvious time delay. [ABSTRACT FROM AUTHOR]

Background: Halving snakebite morbidity and mortality by 2030 requires countries to develop both prevention and treatment strategies. The paucity of data on the global incidence and severity of snakebite envenoming causes challenges prioritizing and mobilising resources for snakebite prevention and treatment. In line with the World Health Organisation's 2019 Snakebite Strategy, this study sought to investigate Eswatini's snakebite epidemiology and outcomes, and identify the socio-geographical factors associated with snakebite risk. Methodology: Programmatic data from the Ministry of Health, Government of Eswatini 2019–2021, was used to assess the epidemiology and outcomes of snakebite in Eswatini. We developed a snake species richness map from the occurrence data of all venomous snakes of medical importance in Eswatini that was subjected to niche modelling. We formulated four risk indices using snake species richness, various geospatial datasets and reported snakebites. A multivariate cluster modelling approach using these indices was developed to estimate risk of snakebite and the outcomes of snakebite in Eswatini. Principal findings: An average of 466 snakebites was recorded annually in Eswatini. Bites were recorded across the entire country and peaked in the evening during summer months. Two cluster risk maps indicated areas of the country with a high probability of snakebite and a high probability of poor snakebite outcomes. The areas with the highest rate of snakebite risk were primarily in the rural and agricultural regions of the country. Significance: These models can be used to inform better snakebite prevention and treatment measures to enable Eswatini to meet the global goal of reducing snakebite morbidity and mortality by 50% by 2030. The supply chain challenges of antivenom affecting southern Africa and the high rates of snakebite identified in our study highlight the need for improved snakebite prevention and treatment tools that can be employed by health care workers stationed at rural, community clinics. Author summary: Snakebite from venomous snakes is a medical emergency requiring immediate critical care by a medical team. Failure to correctly manage a snakebite can lead to permanent disability or even death. The dearth of data on the frequency, location and populations affected by snakebite, as well as the outcomes of snakebite, in many regions of the world means that this tropical disease remains one of the most neglected. We studied snakebite over two years in Eswatini using data on hospitalisations, snake locations, habitat, environmental and socioeconomic factors to develop two nation-wide risk maps: one estimating the probability of snakebite and the other one the probability of poor outcomes in the case of a snakebite. The results of this study can enable national policy makers and health programmes to better plan and allocate resources, as well as implement targeted prevention strategies to meet the global goal of halving deaths and disabilities caused by snakebite envenoming. [ABSTRACT FROM AUTHOR]

Snakes are known as highly fear-evoking animals, eliciting preferential attention and fast detection in humans. We examined the human fear response to snakes in the context of both current and evolutionary experiences, conducting our research in the cradle of humankind, the Horn of Africa. This region is characterized by the frequent occurrence of various snake species, including deadly venomous viperids (adders) and elapids (cobras and mambas). We conducted experiments in Somaliland and compared the results with data from Czech respondents to address the still unresolved questions: To which extent is human fear of snakes affected by evolutionary or current experience and local culture? Can people of both nationalities recognize venomous snakes as a category, or are they only afraid of certain species that are most dangerous in a given area? Are respondents of both nationalities equally afraid of deadly snakes from both families (Viperidae, Elapidae)? We employed a well-established picture-sorting approach, consisting of 48 snake species belonging to four distinct groups. Our results revealed significant agreement among Somali as well as Czech respondents. We found a highly significant effect of the stimulus on perceived fear in both populations. Vipers appeared to be the most salient stimuli in both populations, as they occupied the highest positions according to the reported level of subjectively perceived fear. The position of vipers strongly contrasts with the fear ranking of deadly venomous elapids, which were in lower positions. Fear scores of vipers were significantly higher in both populations, and their best predictor was the body width of the snake. The evolutionary, cultural, and cognitive aspects of this phenomenon are discussed. [ABSTRACT FROM AUTHOR]

The National Action Plan for Prevention and Control of Snakebite Envenoming in India (NAPSE) aims to reduce snakebite-related deaths and disabilities by 50% by 2030 through a comprehensive approach. The plan focuses on increasing awareness, improving access to treatment, strengthening healthcare infrastructure, and enhancing surveillance. Implementation involves multi-tiered coordination, public awareness campaigns, and monitoring systems to track progress and effectiveness. Challenges include ensuring consistent availability of anti-snake venom, training healthcare providers, and accurate reporting of incidents. The success of NAPSE hinges on sustained efforts, stakeholder engagement, and community empowerment to transform snakebite management in India. [Extracted from the article]

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. Author summary: Snakebite envenoming it is a health challenge worldwide. In Brazil, the largest country in Latin America, Bothrops snakebites represents the main cause of envenoming by venomous snakes. Every year, at least 20,000 accidents with Bothrops snakes are notified by The Brazilian Information System for Notifiable Diseases (SINAN). However, it is well known that these numbers do not represent reality in many cases, since a significant portion of envenoming patients continue to dispense specialized medical care or are unable to arrive in time at the reference medical centers. Therefore, in our comprehensive study with secondary data made available online by SINAN, we decided to understand the temporal dynamics of Bothrops snakebites over a ten-year period across the five regions of Brazil. According to our results, which evaluated variables such as occurrence, incidence, mortality and lethality, envenoming by Bothrops snakes remains an important neglected public health problem in our country. Currently, the high rates of occurrence and incidence in certain regions are due to socioeconomic problems found in a vast and developing country such as Brazil. Despite this, lethality and mortality rates remain low at all regions of the country, a fact that can be associated with the effectiveness of the Antivenom therapy treatment provided free of charge by The Brazilian National Health System (SUS). [ABSTRACT FROM AUTHOR]

Background: Snakebite envenomation remains a critical public health concern in India, with its substantial morbidity and mortality burden. Addressing this issue is imperative, as snakebite-related deaths are preventable and yet disproportionately affect vulnerable populations in rural India. Materials and Methods: This autopsy-based study aimed to assess the prevalence and characteristics of lethal snakebite cases in the Guntur region, Andhra Pradesh by considering case data, autopsy findings and ancillary investigation findings. Additionally, an attempt was made to recommend preventive measures and raise awareness among the local population regarding snakebite prevention. Results: Snakebite incidents were more common among males who belonged to the agricultural workforce. These bites predominantly occurred during the rainy season and during daylight hours. The majority of victims were from rural areas, and the incidence was higher among younger individuals. Most of the bites were localized on the lower extremities. Additionally, a significant number of victims experienced fatal outcomes within six hours of envenomation. Conclusion: Snakebite is a highly neglected tropical disease but a preventable one. The Indian government is giving priority to snakebite venomics, proteomics, and the application of recombinant DNA technology for developing antivenoms, diverging from conventional animal-derived sources. Given the wide-ranging biogeographic distribution of venom type in venomous snakes, a re-evaluation of the 'big four' strategy is being advocated, promoting alternative methods for effective antivenom production. [ABSTRACT FROM AUTHOR]

In Portugal, there are four venomous species, the horned viper (Vipera latastei), seoane (Vipera seoanei), rat snake (Malpolon monspessulanus), and the hooded snake (Macroprotodon brevis ibericus), and in the UK, there is one: the common European adder (Vipera berus). Snake venom is a complex mixture of toxins whose composition varies depending on the family, genera, species, and even subspecies. In Europe, particularly Portugal, there are no published data on the frequency of these types of incidents, but it is estimated to be high, mainly in dogs. Thus, to characterize the injuries caused by the bite of venomous snakes in domestic animals, the authors describe cases in dogs, cats, and goats with a suspected snakebite. Animals presented wounds compatible with snakebites, with two points 1 to 1.8 cm apart that could be noted on the head or limbs. The main clinical signs observed included pain, oedema, and necrosis. From the animals that died, a post-mortem examination revealed subcutaneous and muscular necrosis and hemorrhages of surrounding tissues, including muscles and organic hemorrhages. The severity of envenomation depends on the quantity of inoculated venom; the species, age, size, and previous state of health of the bitten animal; the bite location; and post-bite excitability. With this study, the authors hope to help improve the knowledge regarding snakebites in Europe. [ABSTRACT FROM AUTHOR]

Venomous snake bite adversely affects millions of people yearly, but few animal models allow for the determination of toxicodynamic timelines with hemotoxic venoms to characterize the onset and severity of coagulopathy or assess novel, site-directed antivenom strategies. Thus, the goals of this investigation were to create a rabbit model of subcutaneous envenomation to assess venom toxicodynamics and efficacy of ruthenium-based antivenom administration. New Zealand White rabbits were sedated with midazolam via the ear vein and had viscoelastic measurements of whole blood and/or plasmatic coagulation kinetics obtained from ear artery samples. Venoms derived from Crotalus scutulatus scutulatus, Bothrops moojeni, or Calloselasma rhodostoma were injected subcutaneously, and changes in coagulation were determined over three hours and compared to samples obtained prior to envenomation. Other rabbits had ruthenium-based antivenoms injected five minutes after venom injection. Viscoelastic analyses demonstrated diverse toxicodynamic patterns of coagulopathy consistent with the molecular composition of the proteomes of the venoms tested. The antivenoms tested attenuated venom-mediated coagulopathy. A novel rabbit model can be used to characterize the onset and severity of envenomation by diverse proteomes and to assess site-directed antivenoms. Future investigation is planned involving other medically important venoms and antivenom development. [ABSTRACT FROM AUTHOR]

This article provides information about snakes and snakebites. It explains that there are over 3,000 species of snakes in the world, many of which are poisonous. The most common poisonous snake in the United States is the pit viper. Snakebites can be dangerous, but with proper care and treatment, they are unlikely to cause major injury. The article also discusses why snakes bite, the different types of venomous and non-venomous snakes in the United States, and what to do immediately after a snakebite. It emphasizes the importance of seeking medical attention and provides information on how doctors treat snakebites. The article concludes with tips on how to avoid snakebites. [Extracted from the article]

Simple Summary: There are millions of snake envenoming cases annually worldwide, which is an important but often neglected tropical disease. The morbidity and mortality from snake bites are not only caused by the venom toxins but also the secondary infection from bacteria from the snake itself or an external source. Therefore, if we do not understand the actual pathogens of infection, the expected treatment efficacy is reduced. In this study, we investigated the microbiota carried in the oral cavity of seven wild venomous snakes in Taiwan using full-length 16S rRNA next-generation sequencing. The results showed that non-pathogenic bacteria and pathogenic bacteria were similar in dominance in the oral cavity of snakes, Gram-negative bacteria were more common than Gram-positive bacteria, and the microbiota were significantly different between the Elapidae and Viperidae families of snakes. Our findings will assist in resolving the diversity of oral microbiomes in snakes and can be applied to the veterinary medicine and clinical therapy of venomous snakebites. A venomous snake's oral cavity may harbor pathogenic microorganisms that cause secondary infection at the wound site after being bitten. We collected oral samples from 37 individuals belonging to seven species of wild venomous snakes in Taiwan, including Naja atra (Na), Bungarus multicinctus (Bm), Protobothrops mucrosquamatus (Pm), Trimeresurus stejnegeri (Ts), Daboia siamensis (Ds), Deinagkistrodon acutus (Da), and alpine Trimeresurus gracilis (Tg). Bacterial species were identified using full-length 16S rRNA amplicon sequencing analysis, and this is the first study using this technique to investigate the oral microbiota of multiple Taiwanese snake species. Up to 1064 bacterial species were identified from the snake's oral cavities, with 24 pathogenic and 24 non-pathogenic species among the most abundant ones. The most abundant oral bacterial species detected in our study were different from those found in previous studies, which varied by snake species, collection sites, sampling tissues, culture dependence, and analysis methods. Multivariate analysis revealed that the oral bacterial species compositions in Na, Bm, and Pm each were significantly different from the other species, whereas those among Ts, Ds, Da, and Tg showed fewer differences. Herein, we reveal the microbial diversity in multiple species of wild snakes and provide potential therapeutic implications regarding empiric antibiotic selection for wildlife medicine and snakebite management. [ABSTRACT FROM AUTHOR]

The article discusses the presence and management of venomous snakes in zoological parks, emphasizing their historical significance, diversity, and roles in education, conservation, and research. It also examines the incidence of venomous snakebites among zoo staff over the years, highlighting past cases, survey findings, and improvements in safety protocols.

Within the Balkan Peninsula, topographic and climatic agents have promoted biodiversity and shaped the speciation history of many ectotherms. Here, we targeted an iconic European reptile, the nose‐horned viper species‐complex (Vipera ammodytes), and explored its spatial and temporal evolution. We (i) utilized genome‐wide single nucleotide polymorphisms to infer genetic structure and build a time‐calibrated species‐tree, and (ii) applied species distribution modelling with niche‐divergence tests among major phylogenomic clades. Geographically structured genetic diversity was found. Cycles of recurrent isolation and expansion during glacial–interglacial periods led to allopatric speciation and to secondary contacts and formation of multiple hybrid zones throughout the Balkan Peninsula. Deep divergence is still detected among populations separated by old and imminent biogeographical barriers (Pindos Mountain Range, the Cyclades islands, etc.), but in most cases speciation is incomplete. At the other end of the speciation continuum, we recognize two well‐differentiated lineages, currently lacking any evidence of gene flow; one is distributed in the Northwestern Balkans and the other in the Southeastern Balkans, further expanding into Asia. Despite their split 5 million years ago, there is no evidence of ecological divergence, as speciation probably occurred in niche‐pockets of analogous environments. These two lineages probably represent different species, while V. transcaucasiana does not merit species status. By comparing the genomic phylogenies to an updated mitochondrial one, we propose an evolutionary scenario that resolves all mitonuclear conflicts, according to which the history of the V. ammodytes species‐complex was shaped by complex processes, including a major event of introgressive hybridization with asymmetric mitochondrial capture. [ABSTRACT FROM AUTHOR]

Background: Snakebite envenoming is a global health problem, mostly in tropical and subtropical countries. Bangladesh is a subtropical country facing thousands of snakebite envenoming death every year. Knowledge of the distribution of venomous snakes is necessary to identify snakebite-prone areas, develop strategies for prevention and management, and reduce venom-induced mortalities and morbidities. Methods: An integrated effort of direct observations of snakes, qualitative analysis of museum specimen records, clinical records of snakebites, and scholarly literature records were used to understand the pattern of distribution of venomous snakes in Bangladesh. Results: We enlist 65 venomous snake species from Bangladesh and present detailed documentation on their distribution pattern. However, only nine species were considered medically relevant species because of their venom potentiality to kill humans and available clinical records of envenomation. The distribution pattern of those species divides the country into two major portions. A portion consists of northern, northwestern, and western parts of the country, which are habitats of Naja naja, Bungarus caeruleus, and B. lividus. Another portion comprised of the northeastern, southeastern, and southern parts of the country provides habitats for N. kaouthia, B. niger, and Trimeresurus erythrurus. However, Daboia. russelii had a different distribution pattern along the bank of the Padma and Meghna, and some coastal districts. Moreover, B. walli had a scattered distribution over the country. The knowledge of this ecological distribution of venomous snakes across the country bears a significant practical effect on clinical management of snakebite. Treating physicians can have a better understanding of possible offending snake species using this knowledge and the clinical syndromes produced by venoms. Conclusion: Pattern of distribution of medically relevant venomous snakes in Bangladesh approaches to initiate concise and specific bite management strategies for two distinct distributional regions of the country. Moreover, the distribution of D. russelii and B. walli demands specific strategies for bite management. [ABSTRACT FROM AUTHOR]

The World Health Organization has identified snakebite envenoming as a highest priority neglected tropical disease, yet there is a dearth of epidemiologic research on environmental risk factors, including outdoor temperature. Temperature may affect snakebites through human behavior or snake behavior; snakes are ectotherms, meaning outdoor temperatures influence their internal body temperature and thus their behavior. Here we investigate the relationship between short‐term temperature and snakebites in Georgia, one of the most biodiverse US states in terms of herpetofauna. We acquired emergency department (ED) visit data for Georgia between 1 January 2014 and 31 December 2020. Visits for venomous and non‐venomous snakebites were identified using diagnosis codes. For comparison, we also considered visits for non‐snake (e.g., insects, spiders, scorpions) envenomation. Daily meteorology from the Daymet 1 km product was linked to patient residential ZIP codes. We applied a case‐crossover design to estimate associations of daily maximum temperature and snakebite ED visits. During the 7‐year study period, there were 3,908 visits for venomous snakebites, 1,124 visits for non‐venomous bites and 65,187 visits for non‐snake envenomation. Across the entire period, a 1°C increase in same‐day maximum temperature was associated with a 5.6% (95%CI: 4.0–7.3) increase in the odds of venomous snakebite and a 5.8% (95%CI: 3.0–8.8) increase in non‐venomous snakebite. Associations were strongest in the spring. We also observed a positive and significant (p < 0.05) association for non‐snake envenomation, albeit slightly smaller and more consistent across seasons compared to those for snakebites. Plain Language Summary: Tens of thousands of people die from snakebite envenoming every year, yet little is known about how environmental factors contribute to the pattern and frequency of bites. Short‐term changes in ambient temperature likely play a role, as snakes are ectotherms, meaning outdoor temperatures influence their internal body temperature and thus their behavior. Temperature may also influence whether humans engage in activities that increase the likelihood of an interaction with a snake, for example, hiking, gardening or certain occupational tasks. In this study, we investigated the association between ambient temperature and emergency department (ED) visits for snakebite in the US state of Georgia, a state with a high diversity and concentration of venomous snakes. We find that for every 1°C increase in same‐day maximum temperature, the odds of an ED visit for snakebite envenoming increases by ∼6%. This effect size is larger than what we find for envenomation by non‐snake species (e.g., spiders, scorpions etc.), suggesting that snake ecology plays an important role. Key Points: Hospital visits for venomous and non‐venomous snakebite increase with temperatureSeasonal differences in the association may reflect snake behavior and ecologyNon‐snake envenomation (bees, spiders, etc.) is also associated, but less strongly [ABSTRACT FROM AUTHOR]

In spite of the potential richness in biodiversity, Manipur is still one of the least explored areas in northeastern India. In this work, we report on our finding of four pit viper species, namely, Trimeresurus mayaae, T. salazar, T. erythrurus, and Protobothrops jerdonii in Manipur during our herpetological surveys in 2022. We affirm the identity of these specimens based on the combination of standard morphological characters and mitochondrial cytochrome b gene. Our study not only reports four new records of pit vipers for the first time in Manipur, but also extends their respective known geographical ranges. This information calls for further dissemination especially to health care sector, as it is on venomous snakes that could be of medical importance as regards human snakebites. [ABSTRACT FROM AUTHOR]

Venomous snake bites can constitute medical emergencies, and without immediate care may be life-threatening. This study describes the characteristics and management of patients suffering from snake bite injuries (SNIs) in the Jerusalem area. A retrospective analysis of all patients who were admitted to the Hadassah Medical Center emergency departments (EDs) due to SNIs between 1 January 2004 and 31 March 2018 was conducted. During this period, 104 patients were diagnosed with SNIs, of whom 32 (30.7%) were children. Overall, 74 (71.1%) patients were treated with antivenom, 43 (41.3%) were admitted to intensive care units, and 9 (8.6%) required treatment with vasopressors. No mortality was recorded. On ED admission, none of the adult patients presented with an altered mental state compared to 15.6% of the children (p < 0.00001). Cardiovascular symptoms were observed in 18.8% and 5.5% of the children and adults, respectively. Fang marks appeared in all of the children. These findings underscore the severity of SNIs and the differences in clinical presentation between children and adults in the Jerusalem region. [ABSTRACT FROM AUTHOR]

Introduction: In Taiwan, six venomous snake species with medical importance have been found; however, long-term epidemiological data of snakebite envenomation (SBE) is lacking. This study aimed to explore the epidemiology of SBE based on the distribution and use of different antivenoms in different parts of Taiwan to facilitate the development of prevention strategies and resource allocation. Methods and results: This retrospective study was conducted using the Taiwan National Health Insurance Research Database from 2002 to 2014. A total of 12,542 patients were treated with antivenoms. The directly standardized cumulative incidence was 3.6 cases per 100,000 individuals based on the 2000 World Standard Population. The incidence of SBEs peaked in the summer (35.9%). The relative risk (RR) of male patients versus female patients was 2.5 (p < 0.0001). The RRs of patients aged 18–64 and ≥65 years versus those aged <18 years were 6.0 (p < 0.0001) and 14.3 (p < 0.0001), respectively. Furthermore, the RR of eastern Taiwan versus northern Taiwan was 6.8 (p < 0.0001). The RR of agricultural workers versus laborers was 5.5 (p < 0.0001). Compared with patients envenomed by Trimeresurus stejnegeri stejnegeri or Protobothrops mucrosquamatus, those envenomed by Naja atra or Bungarus multicinctus multicinctus were more likely to occur in central (adjusted odds ratio [aOR] = 2.6, p < 0.0001) or southern (aOR = 3.2, p < 0.0001) Taiwan, but less frequently among agricultural workers (aOR = 0.6, p < 0.0001). The overall case-fatality rate was 0.11%. Conclusions: Among Asian countries, Taiwan had low incidence and case-fatality rates of SBE. Risk factors included male gender, old age, summer season, being in eastern Taiwan, and being an agricultural worker. Differences of the epidemiological findings between snake species should be focused on when developing strategies for snakebite prevention. Author summary: SBE is a neglected tropical disease of highest priority to be aware of, and its epidemiology varies widely worldwide. This study explored the nationwide and long-term epidemiology of SBE based on the use of snake antivenom in Taiwan, including its incidence, risk factors, complications, and management. This could facilitate the development of preventive strategies and resource allocation. In Taiwan, six medically important venomous snake species were found; however, majority (73.3%) of the envenomation events were associated with T. s. stejnegeri (bamboo pit viper) and P. mucrosquamatus (Taiwan habu) and some (17.1%) with N. atra (Chinese cobra) and B. m. multicinctus (many-banded krait). The risks varied depending on the season, sex, age, geographic region, and occupation. Compared with patients envenomed by crotalines, those envenomed by elapids were more likely to undergo surgery due to serious wound complications caused by N. atra or endotracheal intubation due to respiratory failure caused by B. m. multicinctus. The low case-fatality rate observed might be due to easy access to modern medicine, immediate availability of antivenoms in healthcare facilities, few adverse effects of antivenoms, and prompt surgical intervention. The lack of highly venomous snakes with highly potent venom is a leading factor in low case fatality. [ABSTRACT FROM AUTHOR]

Europe presents a high number of venomous and poisonous animals able to elicit medically relevant symptoms in humans. However, since most of the accidents involving venomous or poisonous animals in Europe are unreported, their incidence and morbidity are severely overlooked. Here we provide an overview of the European vertebrate species of greatest toxicological interest, the clinical manifestations their toxins can cause, and their treatment. We report the clinical symptoms induced by envenomations and poisoning caused by reptiles, fishes, amphibians and mammals in Europe, ranging from mild, local symptoms (e.g., erythema, edema) to systemic and potentially deadly. The present work constitutes a tool for physicians to recognize envenomation/poisoning symptoms caused by the most medically relevant European vertebrates and to decide which approach is the most appropriate to treat them. [ABSTRACT FROM AUTHOR]

Snakebite is one of the largest risks from wildlife, however little is known about venomous snake distribution, spatial variation in snakebite risk, potential changes in snakebite risk pattern due to climate change, and vulnerable human population. As a consequence, management and prevention of snakebite is hampered by this lack of information. Here we used habitat suitability modeling for 10 medically important venomous snakes to identify high snakebite risk area under climate change in Iran. We identified areas with high snakebite risk in Iran and showed that snakebite risk will increase in some parts of the country. Our results also revealed that mountainous areas (Zagros, Alborz, Kopet–Dagh mountains) will experience highest changes in species composition. We underline that in order to improve snakebite management, areas which were identified with high snakebite risk in Iran need to be prioritized for the distribution of antivenom medication and awareness rising programs among vulnerable human population. [ABSTRACT FROM AUTHOR]

Envenomation caused by venomous animals may trigger significant local complications such as pain, edema, localized hemorrhage, and tissue necrosis, in addition to complications such as dermonecrosis, myonecrosis, and even amputations. This systematic review aims to evaluate scientific evidence on therapies used to target local effects caused by envenomation. The PubMed, MEDLINE, and LILACS databases were used to perform a literature search on the topic. The review was based on studies that cited procedures performed on local injuries following envenomation with the aim of being an adjuvant therapeutic strategy. The literature regarding local treatments used following envenomation reports the use of several alternative methods and/or therapies. The venomous animals found in the search were snakes (82.05%), insects (2.56%), spiders (2.56%), scorpions (2.56%), and others (jellyfish, centipede, sea urchin—10.26%). In regard to the treatments, the use of tourniquets, corticosteroids, antihistamines, and cryotherapy is questionable, as well as the use of plants and oils. Low-intensity lasers stand out as a possible therapeutic tool for these injuries. Local complications can progress to serious conditions and may result in physical disabilities and sequelae. This study compiled information on adjuvant therapeutic measures and underscores the importance of more robust scientific evidence for recommendations that act on local effects together with the antivenom. [ABSTRACT FROM AUTHOR]