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Objectives: This study aimed to analyse the epidemiological patterns of paediatric snake bites in Sri Lanka over a 4-year period (2020–2024). Methods: A multi-centre, retrospective observational study was conducted from June 2020 to June 2024 across nine governmental hospitals in seven provinces of Sri Lanka. Data were collected based on 757 children presenting with snake bites. The snake bites were analysed based on age, gender, and seasonal variations. Data on the type of snake involved, geographic variations and the temporal trends in snake bite occurrences were also analysed. Results: The mean age of the 757 children recruited to the study was 10.3 years (SD—5.00, range—0.1–17 years). Males (57.7%) were significantly more affected than females (42.3%) (p < 0.05). Visual identification confirmed the snake species in 58.4% of cases. The hump-nosed viper (16.7%), Russell's viper (14.7%), and common krait (12.9%) were the most common medically important snakes identified in the study. Seasonal peaks in snake bites occurred in May–July and November–December. An increasing trend in snake bite incidence was noted over the first three years, with a slight decline in the final year. Conclusion: Paediatric snake bites in Sri Lanka show significant age, gender, and seasonal patterns. Targeted public health interventions are needed to mitigate the impact on children. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Snakebite envenoming remains a public health threat in many tropical countries. While community knowledge of local snakes and snakebite first‐aid and prevention are needed to reduce snakebite incidence and improve the outcomes for snakebite patients, it is poor in many communities. We assessed community health workers and community members regarding their knowledge on local snakes, snakebite first‐aid and prevention in Neno district, Malawi.In November 2022, we conducted a cross‐sectional survey among 312 community health workers and 379 community members in the Neno District of Malawi to assess their knowledge of snake identification, snakebite first‐aid, and prevention. Different questions were asked in these sections and summarised as linear scores ranging from 0% to 100%. Scores of 0%–49%, 50%–70%, and >70% were considered inadequate, fairly adequate, and adequate, respectively. Along with data collected during knowledge assessments, the socio‐demographic characteristics of participants were collected. To assess knowledge differences between community health workers and community members, Pearson's chi‐square or Fisher's exact tests were used, and linear regression was calculated to investigate possible predictors of knowledge.Overall, 66.6% of participants were females with a median age of 39 (IQR = 30–48) years. Of the 89% (n = 615) who agreed to view snake pictures, only 1.3% had adequate snake identification knowledge. Less than 5% (n = 33) had adequate knowledge of first aid measures, and 14.3% (n = 99) had adequate knowledge of prevention practices. Overall, less than 1% (n = 3) had adequate knowledge across the three assessment sections, with no significant difference between community health workers (n = 1, 0.3%) and community members (n = 2, 0.5%) (p > 0.949).Both community health workers and community members had inadequate knowledge regarding local snake species, first aid for snakebites and prevention measures. The effect of awareness campaigns and other education initiatives could be explored to help improve these gaps. [ABSTRACT FROM AUTHOR]

This study offers considerable information on plant wealth of therapeutic importance used traditionally by the residents of 11 villages under three subdivisions of Kurseong, Darjeeling Sadar, and Mirik in the Darjeeling District, West Bengal. For the acquisition of ethnomedicinal information, semi-structured interviews were conducted with 47 informants, of whom 11 persons were herbalists and 36 were knowledgeable persons. Free prior informed consent was obtained from each participant prior to the collection of field data. A total of 115 species were documented, which spread over 65 families and 104 genera. From the informants, a total of 101 monoherbal and 21 polyherbal formulations were recorded for treating 50 types of health conditions. The collected ethnobotanical data have been evaluated to measure the utilitarian significance of remedies using three quantitative tools, informant consensus factor (Fic), use value (UV), and fidelity level (FL%). A statistical analysis revealed that among 11 disease categories, the highest Fic value was estimated for the category of digestive diseases. The plant Hellenia speciosa (J.Koenig) S.R.Dutta scored the highest use value among all the recorded plant species. In the case of the FL% analysis, the highest score (97%) was observed in Betula alnoides Buch-Ham. ex D.Don, which is used for snake bites, among the recorded 115 plant species. In addition, the present study embodies the quantitative estimation of phenolics and flavonoids, along with an HPLC analysis of the B. alnoides bark to endorse this most important and underexplored plant as a potential source of therapeutically important chemical compounds. The bark extract contains significant amounts of phenolics (87.8 mg GAE/g dry tissue) and flavonoids (30.1 mg CE/g dry tissue). An HPLC analysis unveiled a captivating ensemble of six phenolic compounds, namely, chlorogenic acid, sinapic acid, caffeic acid, coumarin, p-coumaric acid, and gallic acid. Among the identified phenolics, chlorogenic acid scored the highest amount of 117.5 mg/g of dry tissue. The present study also explored the moderate cytotoxic nature of the bark extract through an in vitro cytotoxicity assay on the L929 mouse fibroblast cell line. Our study not only documents the statistically analyzed information about ethnomedicinal practices that prevailed in the rural communities of the Darjeeling District but also highlights the profound therapeutic capabilities and non-toxic nature of B. alnoides bark. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsDiscussionConclusionEarly antivenom administration is essential for effective treatment. We investigated the delays in antivenom administration.We reviewed snakebites from the Australian Snakebite Project (2006–2021) given antivenom, presenting to hospital within 12 h. We extracted demographics, snake type, time of bite, hospital arrival, blood collection, antivenom treatment and hospital transfer.There were 2,169 patients recruited to Australian Snakebite Project 1,132 patients received antivenom within 12 h of the bite, and 1,019 of these were envenomated: median age 41 years (IQR: 24–57 years); 738 (72%) males. A pressure bandage was applied in 950 (93%), a median of 15 min (IQR: 5–30 min) post-bite. Specific snakes were identified by venom assays in 855 patients (80%), including 328 brown snakes (32%), 173 tiger snakes (17%), 74 rough-scaled snakes (7%), 85 red-bellied black snakes (8%), 49 taipans (5%) and 26 death adders (3%). Seventy-seven patients (7%) received antivenom without envenomation. The median length of hospital stay was 41 h (IQR: 24–67 h). The median time to hospital was 60 min (IQR: 30–105 min), to first blood tests was 90 min (IQR: 59–154 min) and to antivenom was 235 min (IQR: 155–345 min). There was a median delay in blood tests of 20 min (IQR: 10–37 min) and a median delay to antivenom of 147 min (IQR: 84–249 min). Non-specific systemic symptoms occurred in 641 (63%) patients, which occurred a median of 24 min (IQR: 10–60 min) post-bite, which was at a median of 180 min (IQR: 106 to 275 min) prior to antivenom administration. Time to antivenom in the 314 transferred patients was similar to those not transferred. Time to antivenom was significantly shorter for 189 patients given antivenom prior to transfer, median 183 min (IQR: 110–270 min), compared to 130 patients given antivenom after transfer, median 363 min (IQR: 289–513 min; P <0.001).Antivenom administration was delayed on average by 2.5 h after hospital presentation, despite three-quarters arriving in hospital within 3 h, the optimal time for antivenom administration. Patients requiring transfer received antivenom in a similar time, but earlier if administered prior to transfer, highlighting the possible benefits of pragmatic clinical decision-making prior to blood tests.We found the leading cause of delays to antivenom administration after patients arrive in hospital was waiting for blood results. Systemic symptoms occurred early in most cases and could be given greater weight in decisions about early antivenom. [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]

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]

Aim: Cyclophosphamide (CP) is used as antineoplastic agent. However, anticancer therapy is largely impeded by its toxicity arising from oxidative stress. Strategies that can attenuate this off‐target effect of CP could be helpful. Commelina benghalensis L. is widely used in oriental traditional medicine for management of jaundice, fever, inflammation, leprosy and snake bites; its potential against chemotherapy‐induced hepatotoxicity is unknown. The present study evaluates the hepatoprotective effect of hydro‐ethanolic extract of C. benghalensis (HECB) in a rat model of CP‐induced hepatotoxicity. Methods: Chemical characterization of HECB was carried out followed by 2,2‐diphenyl‐1‐picrylhydrazyl (DPPH) assay. Hepatic functional tests including phenobarbitone‐induced sleeping time were done and anti‐oxidant reserves were estimated after oral treatments at 50 and 100 mg/kg for eight weeks. Inflammatory markers and mitochondrial integrity (complex I activity, nuclear factor erythroid 2–related factor 2 [Nrf2] and mitochondrial transcriptional factor A [TFAM] levels) were analyzed in the tissue lysates. Results: Flavonoids and phenolic compounds were found at higher concentrations of 50 and 100 μg/mL with a significant free radical scavenging activity as displayed by DPPH assay. Administration of CP has resulted in increased liver weight, elevated serum hepatic enzyme activity along with inflammatory markers, decreased hepatic anti‐oxidant reserves, and impaired mitochondrial activity. Correspondingly, daily oral administration of HECB ameliorated these parameters and restored anti‐oxidant reserves. Further, hepatic mitochondrial activity, Nrf2 and TFAM levels were also improved. The hepatoprotective effect of HECB was further confirmed by histopathological analysis and phenobarbitone‐induced sleeping time. Conclusion: Conclusively, the study provides preliminary evidence regarding the hepatoprotective activity of HECB and the contribution of its anti‐oxidant potential towards this pharmacological effect. [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]

Snakebites and their consequences are a growing concern around the globe. The mixture of enzymes, present in snake venom is a great challenge for a snakebite victim's body. European adder (Vipera berus) is considered as not very harmful snake due to the mild clinical symptoms of envenomation and rare cases of cardiovascular or pulmonary failure. Nevertheless, at the molecular level, many details of V. berus bite (including proteostasis instability) remain unclear. This work was aimed to determine the effect of Eastern Europe typical adder species Vipera berus berus and Vipera berus nikolskii envenomation on the protein homeostasis of rat's lung tissue. The decrease in total protein concentration, significant redistribution of main protein fractions (including proteolytically active), rise in middle-mass molecules and low molecular weight peptide concentration have been observed during V. b. berus and V. b. nikolskii envenomation, strongly indicating the proteostasis collapse and endogenous intoxication in lung tissue as an effect of European adder snakebite. Moreover, according to the results of experiments, the effect of V. b. nikolskii venom is more harmful to lung tissue protein homeostasis, comparing to V. b. berus, suggesting that the former may represent a greater danger to people. The results of this study may find applications in antivenom development and could be taken into consideration for proper snakebite treatment selection in order to avoid proteome complications in patients. [ABSTRACT FROM AUTHOR]

Acanthospermum hispidum DC (Asteraceae), a traditional medicinal plant, plays a role as an alternative remedy for various diseases, such as bacterial and viral infections, jaundice, malaria, fever, gastrointestinal disorders, headache, convulsions, and snake bites. Flavonoids, alkaloids, saponins, tannins, terpenes, steroids, and cardioactive glycosides are the distinct classes of metabolites in the plant. Although A. hispidum was suggested as a promising antitumor phytomedicine, no studies identified its potential cytotoxic components. In this study, the cytotoxic compounds of A. hispidum were isolated using chromatographic techniques guided by in vitro MTT cytotoxicity assay against selected cancer cell lines; breast cancer (MCF7), colorectal adenocarcinoma (HT29), and hepatoblastoma (HepG2). The selective index (SI) was assessed on MRC5 (Normal human fetal lung fibroblast) cell line. The dichloromethane fraction (DCM) showed remarkable cytotoxic activity against MCF7 and HT29 (%Cell viability; 46.15 and 60.5, respectively). Hence, the main bioactive fraction from DCM was purified to afford two phytosterols; stigmasterol (1) and β-sitosterol (2), which were identified by 1-D and 2-D NMR spectroscopy. Cytotoxic evaluation of 1 and 2 revealed that β-sitosterol showed better selective cytotoxicity against MCF7 and HT29 (IC50 4.07 μg/mL, SI 2.63; IC50 4.52 μg/mL, SI 2.37) compared to stigmasterol (IC50 5.43 μg/mL, SI 1.38; IC50 4.21 μg/mL, SI 1.78), respectively. Bioinformatic assessments of drug-likeness and ADMET properties demonstrated that most criteria were obeyed by the investigated compounds except for their poor solubility, which recommended the preparation of special dosage forms, such as nanoformulation to enhance their oral bioavailability. Swiss Target prediction indicated that nuclear receptors represent the main target class (40%). Whereas caspase-3 stimulant activity (a key enzyme in apoptosis) was predicted by the PASS prediction tool as a potential anticancer mechanism. Our study suggests A. hispidum as a potential source of bioactive phytosterols and as a chemopreventive medicinal plant. [ABSTRACT FROM AUTHOR]

Leptadenia reticulata is a vital Ayurvedic medicinal herb, commonly known as Jivanti or Jiv, and contains revitalising, rejuvenating, and lactogenic activities. It has been used in traditional medicine for treating respiratory disorders, wounds, inflammation, cough, dehydration, tuberculosis, colitis, chickenpox, dysentery, eye diseases, night blindness, fever, and snake bites. It is a perennial herb of Indian origin belonging to the Asclepiadaceae family and has been utilised for its therapeutic properties since ancient times. It is a key ingredient in several marketed herbal drugs, including chyawanprash, speman, and leptaden. Several potent compounds, including β-sitosterol, γ-sitosterol, phytol, α-amyrin, β-amyrin, apigenin, reticulin, deniculatin, leptaculatin, diosmetin, and rutin are present in this herb and attributed various pharmacological activities, including antidiabetic, antimicrobial, antioxidant, anti-abortifacient, anticancer, antipyretic, analgesic, anti-inflammatory, and antiulcer properties. This review provides an in-depth analysis of the distribution, ethnobotanical use, botanical description, phytocompounds, and pharmacological activities of Leptadenia reticulata. HIGHLIGHTS: Leptadenia reticulata is a vital Ayurvedic herb containing revitalising, rejuvenating, and lactogenic activities. It is present in polyherbal formulations chyawanprash, speman, and leptaden. Its secondary metabolites have anticancer, anticholesterol, antidiabetic, antiabortifacient, and anti-inflammatory potential. This review shows the distribution, morphology, and therapeutic potential of Leptadenia reticulata. A summary of the phytochemicals present in Leptadenia reticulata will also be provided. [ABSTRACT FROM AUTHOR]

The Big Four snakes are the leading causes of snakebite mortality in India. Among them, The Indian spectacled cobra (Naja naja) and common krait (Bungarus caeruleus) contribute about one-third of the deaths. The conventional anti-snake venoms (ASV) produced from equine serum are found to be expensive, with a high frequency of clinical side effects, low specificity, and production drawbacks. The current study, therefore, attempted to develop chicken egg yolk immunoglobulins (IgY) as antivenoms against the venoms of cobra and krait venoms. The major pathophysiological properties of the venoms and the efficacy of monovalent ASV IgY were evaluated. The titer of anti-cobra and anti-krait IgY was found to be 1:64000 on the 145th day post-immunization. The results showed that venoms (lethal doses (LD50): cobra:0.375 mg/kg, krait:0.0375 mg/kg of mice) had hemolytic, pro-coagulant, inflammatory, hemorrhagic, and edematic activities that were effectively neutralized by ASV-IgY. 1 mL of monovalent ASV IgY was able to neutralize 0.22 mg of cobra venom and 0.028 mg of krait venom whereas 1 mL of commercial polyvalent antivenom was able to neutralize 0.28 mg of cobra venom and 0.035 mg of krait venom. The study results suggest that using chicken IgY as an monovalent antivenom could effectively treat snakebites. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMethodsResultsDiscussionConclusionPit viper envenomation causes tissue damage that can persist for weeks to months despite antivenom. Many patients do not receive post-discharge care beyond testing for late coagulopathy and primary care follow-up. The aim of this report is to describe a snake envenomation patient cohort, complications, and management strategies after three years of operation of a specialized outpatient clinic offering post-discharge evaluation and wound care therapy.This was an observational study of patients treated in a newly established snakebite follow-up clinic from June 1, 2021 to November 30, 2023. Patient demographics, snake species, and hospital course were abstracted from poison center records. Persistent symptoms upon clinic evaluation were recorded as well as the therapies prescribed by the clinic wound care physicians.Of the 465 snake envenomations reported to the state poison center, 52 patients presented to the clinic. The median patient age was 29 years (range 5–88 years), and the majority (65.4%) were male. Antivenom was given during hospitalization in 92.3% of cases. Agkistrodon spp. envenomations (including Agkistrodon contortrix and Agkistrodon piscivorus) were most common (n = 33) with a smaller number of Crotalus horridus (n = 7) and 12 unidentified pit viper envenomations. Persistent edema (61.5%) and bullae (38.5%) were common at follow-up. Interventions provided included compression (38.5%), physical therapy referral (32.7%), tissue debridement (9.6%), and antibiotics (5.8%). Rates of edema and bullae were numerically higher in patients envenomated by Agkistrodon spp. compared to those envenomated by Crotalus horridus.In this primarily Agkistrodon spp.-envenomated cohort, persistent edema, wounds, and functional limitations were common in the post-discharge period. Our outpatient snake envenomation clinic leveraged the expertise of wound care physicians and the public health reach of the state poison center to address the significant morbidity seen on follow-up and provide interventions to facilitate recovery.This snake envenomation wound care clinic addressed a neglected aspect of pit viper envenomation by providing post-discharge management of enduring tissue damage and other complications. [ABSTRACT FROM AUTHOR]

The article focuses on the health risks of flooding, highlighting both immediate dangers like drowning and injury, and long-term effects such as disease spread and worsened health conditions. It emphasizes the increasing frequency of floods due to climate change and discusses strategies to reduce these risks through better preparedness and response.

Snakebite is a major public health concern in many parts of the world, including India, where over 58,000 deaths occur annually due to snake envenoming. The common krait (Bungarus caeruleus) is responsible for the second-highest number of snakebite-related mortalities in the country. However, despite its notoriety, little is known about its venom ecology, functions and compositional variation across bioclimatic zones, partly because these nocturnal snakes are highly elusive, making it difficult to find them in the wild. We aim to address this knowledge gap by characterising the venom composition and toxicity profiles of the pan-Indian populations (n = 8) of B. caeruleus using a combination of proteomics, receptor-toxin interaction assays, biochemical experiments, pharmacological tests and preclinical evaluations. We reveal considerable variation in venom composition, functions, and pharmacological activities among the geographically distinct populations of B. caeruleus. Furthermore, toxin-receptor interaction assays provide insights into their feeding ecology and prey-predator interactions. Finally, in vitro and in vivo experiments revealed the poor neutralising potencies of Indian antivenoms towards most populations of the common krait. Our findings highlight the alarming need to develop efficacious snakebite therapy in India to treat bites from this medically most important elapid snake. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Compartment syndrome of the forearm has been associated with a variety of etiologies, including fractures, snake bites, complications of certain infections, and, very rarely, spider bites. Loxoscelism is the venom-related clinical manifestation of the bite of spiders of the genus Loxosceles, also called brown or fiddler (violinist) spiders. It manifests locally/regionally with pain, erythema, and edema, with subsequent necrotic plaque formation at the site of the bite. This condition can threaten the function and integrity of the limbs and, in severe cases, can be life-threatening. The basis of treatment is surgical decompression of the affected compartments to restore limb perfusion and avoid irreversible sequelae. Case Report: A 62-year-old male patient, without comorbidities, had edematous cutaneous loxoscelism and secondary development of acute compartment syndrome of the right forearm. He promptly visited the Emergency Department and underwent surgical treatment, in addition to the application of pharmacological treatment, under a multi-disciplinary team. The evolution was favorable. The biochemical levels of rhabdomyolysis decreased, the compartment syndrome resolved, the fasciotomies were closed, and the patient was discharged without further complications. Conclusions: Although arachnid bites are relatively uncommon in urban hospitals, it is crucial that general, vascular, and plastic surgeons maintain a high index of clinical suspicion for acute compartment syndrome. It is important to make an accurate differential diagnosis, and equally important is the interdisciplinary approach to treating this condition, ensuring prompt medical treatment and, if necessary, early surgical intervention. [ABSTRACT FROM AUTHOR]

Background: A specific phobia is an anxiety disorder that is characterised by persistent and excessive fear in the presence of the object of the phobia. Animal phobias are the most prevalent forms of specific phobia among humans. Fear of snakes (snake phobia) is present in non-human primates which suggests its evolutionary origins as the ability to detect the threat of snakes was critical for survival. Snake phobia is a critical factor in protecting snakes and mitigating snakebite burden. To date, only one standardised psychometric test [the Snake Questionnaire (SNAQ) developed in 1974] has been used to quantify snake phobia although this was not performed in snakebite-endemic countries. In this study, we aimed to determine snake phobia in India, where snakebites and resulting deaths, disabilities and socioeconomic impacts are high. Methodology/Principal findings: A modified version of the SNAQ (i.e. SNAQ12), which has previously demonstrated internal consistency, excellent reliability, and good discrimination between phobics and non-phobics in Europe was used in this study. SNAQ12 was developed both in English and Tamil and validated by testing on several individuals. Then, the final questionnaire was disseminated to members of the public through various methods including social media and in person through academic and clinical organisations. We received a total of 2032 responses, comprising 1086 [53.4%] males and 946 [46.6%] females, and these data were analysed to determine various aspects of snake phobia in the study population. Conclusions/Significance: The results demonstrated good internal consistency in using SNAQ12 to determine the phobia amongst the tested population. The data suggests that males are more snake-phobic in all age groups than females in India, in contrast to previous research that suggested that females are usually more snake-phobic. No other critical factors contribute to snake phobia in this study population. The use of the SNAQ12 allowed us to easily discriminate between individuals with phobia and non-clinical controls. This tool can be used as part of the One Health approach to better understand the relationships between snake phobia and snakebites and their impact on the mental health and well-being of vulnerable populations. Author summary: Snakebite envenoming often occurs due to unnecessary human-snake conflicts. Fear of snakes is a key factor in driving this conflict which frequently results in killing snakes. To protect humans from snakebites and snakes from humans, it is critical to estimate the level of snake phobia among vulnerable communities. Therefore, in this study, we used a robust online questionnaire (SNAQ12) to measure the level of snake phobia among members of the public in India, which is the capital of snakebites. SNAQ12 was developed in English and a local language, Tamil and validated before disseminating to members of the public through several methods. We received over 2000 responses, and the data analysis confirmed the internal consistency and robustness of this questionnaire for Indian communities. The data demonstrated that males across all age groups are more phobic to snakes than females in India. The phobia was not dependent on any other factors such as age and education levels. While this study has some limitations, it forms the basis for further research to determine the level of phobia before and after snakebites and develop robust strategies to tackle this condition. We believe that preventing and treating snake phobia will aid in mitigating snakebite burden and promoting snake conservation in India. [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]

Introduction: Envenomation after a North American rattlesnake (Crotalus spp. and Sistrusus spp.) bite is associated with substantial morbidity. Arizona reports the highest number of rattlesnake envenomations annually in the United States. We evaluated the performance of poison and drug information centers for snakebite surveillance, compared with the hospital and emergency department discharge database. We used both datasets to improve the characterization of epidemiology, healthcare costs, and clinical effects of snakebite envenomations in Arizona. Methods: We identified patients with a snakebite during 2017–2021 using Arizona hospital and emergency department discharge data and snakebite consults with two regional Arizona poison centers. Patients were matched using name and birthdate. The performance of poison center data for snakebite surveillance was evaluated using the percentage of snakebite patients in hospital and emergency department discharge data that consulted with poison centers. Patient demographics, healthcare characteristics, clinical effects, and context of snakebite events were described using both datasets. Results: In total, 1,288 patients with a snakebite were identified using the Arizona hospital and emergency department discharge data, which resulted in 953 (74%) consultations with poison centers. The median age of patients was 48 years (IQR 28-62 years), and they were predominantly male (66%), White (90%), and non-Hispanic (84%). The median billed charges were US$ 84,880 (IQR US$ 13,286–US$ 168,043); the median duration of a healthcare stay was 34 h (IQR 13–48 h), and 29% of patients were transferred between healthcare facilities. Among 953 consulted poison center calls for a snakebite, a median of 14 vials of antivenom was administered per patient; 375 (60%) bites occurred near the home, and 345 (43%) patients were bitten on a lower extremity. One death was identified. Discussion: Snakebites in Arizona can cause severe morbidity and require extensive healthcare resources for treatment. Poison centers are valuable for monitoring venomous snakebites in Arizona. Conclusions: Using hospital and emergency department discharge data with poison center records can improve public health surveillance data regarding snakebite epidemiology and human-snake interaction information and be used to tailor interventions to increase awareness of snake encounters and prevent snakebites. [ABSTRACT FROM AUTHOR]

ABSTRACT: Guillain–Barre syndrome (GBS) is an autoimmune disorder affecting the peripheral nervous system, often triggered by infections. This important medical emergency can also have noninfectious causes, such as trauma, surgery, medication (including vaccinations), and other systemic disorders. Here, we present a rare case of GBS following a snakebite. A 19-year-old man presented to the emergency department with quadriparesis and areflexia after showing initial recovery from a snakebite. Nerve conduction studies revealed motor axonal polyneuropathy. He was treated with intravenous immunoglobulin, which improved his clinical condition. This case report highlights a rare cause of GBS and emphasizes that timely recognition and treatment can significantly reduce morbidity and mortality. Additionally, we reviewed past literature of this rare association. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Snake bite is a well-known occupational hazard amongst farmers, plantation workers, and other outdoor workers and results in much morbidity and mortality throughout the world. The complications related to kidneys are observed in most patients with snake bites admitted to a hospital. The current study aimed to study the renal involvement in patients with snake bites with reference to clinical features and the time of onset of acute renal failure. Methods: A prospective clinical study of 68 patients of snake bite was done to know the clinical profile and outcome in Gandhi Hospital Secunderabad and cases were particularly looked for development of acute kidney injury. Later each case was studied and investigated with respect to onset, clinical features, course in the hospital, need for renal replacement therapy including dialysis, and mortality due to AKI. Patients were followed up till discharge or death. They were treated as per protocol. Results: The incidence of AKI was 29.1%. Common signs and symptoms were fang mark (100%), swelling (91.2%), tenderness (91.2%), bleeding manifestations (79.4%) oliguria (26.47%), anuria (5.8%), and haematuria (8.8%). Hypotension was present in 73%, which may be the cause of AKI. All the AKI patients showed coagulation abnormalities in the form of prolonged BT, CT, PT, and aPTT. Thrombocytopenia was seen in 29.4%. All the AKI patients were given ASV for 2 to 3 days. The mean ASV vials used in the present study is 15 ± 5. Hemodialysis was done in 29.4% of patients. Conclusion: The cause of AKI in snakebite was multifactorial in origin. Bleeding and hypotension were among the important causes. Thrombocytopenia was significantly related to clinical bleeding. The type of snakebite is an important factor in the development of AKI and Russell's viper bite is more commonly associated with it. AKI is usually associated with oliguria and generally occurs within 48 hours. [ABSTRACT FROM AUTHOR]

To enhance the understanding of rhabdomyolysis (RM) caused by snakebites and to promptly identify and intervene in the risk factors associated with RM. Methods: A retrospective analysis involving 209 snakebite victims who visited our hospital for snakebite cases was conducted. Among these, 43 were related to RM, while 166 did not exhibit RM (NRM). The clinical characteristics, treatment, and prognostic outcomes of both groups were statistically analyzed, with the aim of interpreting the risk factors associated with snakebites concurrent with RM through logistic regression analysis. Results: Snakebite incidents commonly manifest during the summer and autumn seasons, predominantly affecting middle-aged and elderly populations, with injuries mostly occurring in the limbs. Creatine kinase (CK), CK isoenzyme MB, and lactate dehydrogenase indicators exhibited significantly elevated levels in the RM group compared to the NRM group (P < 0.05). Moreover, the RM Group displayed heightened susceptibility to complications such as osteofascial compartment syndrome, multiple organ dysfunction (MODS), acute kidney injury, etc. (P < 0.05). Debridement and blood purification procedures were more frequently administered to the RM group in comparison to the NRM group (P < 0.05). Notably, visitation beyond 6 hours post-bite and hemoglobin levels below 90 mg/dl emerged as independent risk factors for those with RM following snakebites, while female gender and albumin levels > 40 g/L were identified as protective factors against such occurrences. Conclusion: Snakebite victims with RM have more severe clinical conditions, necessitating prolonged treatment duration, and exhibit heightened mortality rates in comparison to those without RM. [ABSTRACT FROM AUTHOR]

Background: The venom of Bothrops lanceolatus, a viperid species endemic to the Lesser Antillean Island of Martinique, induces thrombosis in a number of patients. Previous clinical observations indicate that thrombotic events are more common in patients bitten by juvenile specimens. There is a need to develop an experimental model of this effect in order to study the mechanisms involved. Methodology/Principal findings: The venoms of juvenile and adult specimens of B. lanceolatus were compared by (a) describing their proteome, (b) assessing their ability to induce thrombosis in a mouse model, and (c) evaluating their in vitro procoagulant activity and in vivo hemostasis alterations. Venom proteomes of juvenile and adult specimens were highly similar, albeit showing some differences. When injected by the intraperitoneal (i.p.) route, the venom of juvenile specimens induced the formation of abundant thrombi in the pulmonary vasculature, whereas this effect was less frequent in the case of adult venom. Thrombosis was not abrogated by the metalloproteinase inhibitor Batimastat. Both venoms showed a weak in vitro procoagulant effect on citrated mouse plasma and bovine fibrinogen. When administered intravenously (i.v.) venoms did not affect classical clotting tests (prothrombin time and activated partial thromboplastin time) but caused a partial drop in fibrinogen concentration. The venom of juvenile specimens induced partial alterations in some rotational thromboelastometry parameters after i.v. injection. When venoms were administered i.p., only minor alterations in classical clotting tests were observed with juvenile venom, and no changes occurred for either venom in rotational thromboelastometry parameters. Both juvenile and adult venoms induced a marked thrombocytopenia after i.p. injection. Conclusions/Significance: An experimental model of the thrombotic effect induced by B. lanceolatus venom was developed. This effect is more pronounced in the case of venom of juvenile specimens, despite the observation that juvenile and adult venom proteomes are similar. Adult and juvenile venoms do not induce a consumption coagulopathy characteristic of other Bothrops sp venoms. Both venoms induce a conspicuous thrombocytopenia. This experimental model reproduces the main clinical findings described in these envenomings and should be useful to understand the mechanisms of the thrombotic effect. Author summary: Envenomings by the viperid species Bothrops lanceolatus, endemic of the Caribbean Island of Martinique, are characterized by a thrombotic effect responsible for infarcts in various organs. Until now, no experimental in vivo models of this effect have been described. In this study, we developed a mouse model of thrombosis by using the intraperitoneal route of venom injection. The venom of juvenile specimens of B. lanceolatus induced the formation of abundant thrombi in the lungs, whereas the effect was much less pronounced with the venom of adult specimens. This difference in the ability of juvenile and adult venoms occurs despite both venoms having highly similar proteomic profiles. Both adult and juvenile venoms showed a weak in vitro procoagulant effect on plasma and fibrinogen, underscoring a thrombin-like (pseudo-procoagulant) activity. In vivo, the venoms did not affect the classical clotting tests (prothrombin time and activated partial thromboplastin time) but induced a partial drop in fibrinogen concentration and limited alterations in rotational thromboelastometry parameters when injected by the i.v. route. In contrast, few alterations of these parameters were observed after i.p. injection of venoms, in conditions in which thrombosis occurred, hence evidencing the lack of a consumption coagulopathy. After i.p. injection both venoms induced a pronounced thrombocytopenia. This experimental model reproduces some of the main clinical manifestations of envenoming by this species. This model can be used to identify the toxins responsible for the thrombotic effect, to study the mechanism(s) of thrombosis and to assess the preclinical efficacy of antivenoms and novel therapies. [ABSTRACT FROM AUTHOR]

Capillary leak syndrome is a unique complication characterized by extravasation of liquids in the interstitial space due to protein loss caused by snakebite envenoming. We describe the case of a 12-year-old boy from the district of Napo in the city of Iquitos in the Peruvian Amazon, who had edema and increased face volume due to the bite of a snake of the Bothrops genus in the lateral aspect of the right leg; he was the hospitalized and diagnosed with severe ophidism complicated with face edema. The patient received eight vials of antivenin, antibiotics and analgesics. Finally, the patient was discharged from the hospital after eight days of hospitalization, with favorable evolution and recovery. [ABSTRACT FROM AUTHOR]

Background: Snakebites continue to be a major public health concern throughout the world, and more in tropical countries. Cardiac implications are poorly understood due to the low frequency of cardiotoxicity combined with a lack of robust information. Aims: We aim to study the cardiac profile, complications in snake bite patients requiring admission in a medical unit. Materials and Methods: This retrospective study was conducted carried out from 01/05/2016 to 01/05/2021. The data was extracted from the inpatient medical records and it was analyzed. All adult patients requiring admission in a Medicine unit with a diagnosis of snake envenomation were included. Descriptive statistics were obtained for all variables in the study and appropriate statistical tests were employed to ascertain the significance. Result: The cohort consists of 80 patients with 45(56.3%) males and aged 40.06 ± 15.24 years (mean, SD). The majority of the Snake species identification was not available 38(47.5%). Viper bite was the commonest bite 32 (40%). The commonest clinical presentation was hemotoxic 33 (31.3%) followed by neurotoxic 16(20%). Electrocardiogram abnormalities were seen in 23 (28.7%) patients and commonest abnormality noted was sinus tachycardia 34(42.5%) of cases. 69 (86%) patients had cellulitis and 16(20%) had acute kidney injury (AKI). Twenty-four (30%) required intensive care monitoring, 22 (27.5%) required mechanical ventilation and 7 (8.8%) patients required hemodialysis. The mean ± SD duration of hospital stay was of 5.56 ± 3.76 days. The median direct cost was Rs 19714.5 and cost on medicine was Rs 10798. The mortality in this cohort was 4(5%). Conclusion: Snake bite causes significant morbidity. Viper bite was the commonest bite in our study. The mortality in this cohort was 4(5%). Cardiac toxicity is a clearly defined toxicity following snake bite envenomation however it has no effect on mortality. [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]

In the Brazilian Amazon, snakebite envenomations (SBEs) disproportionately affect Indigenous populations, and have a significantly higher incidence and lethality than in non‐Indigenous populations. This qualitative study describes the Indigenous and biomedical healthcare domains for SBE care from the perspective of the Indigenous medical and nursing students in Manaus, Western Brazilian Amazon. In‐depth interviews were conducted with five Indigenous students from the Amazonas State University, between January and December 2021. The interviews were analyzed using inductive content analysis. We organized an explanatory model with five themes: (1) participants' identities; (2) causality levels in Indigenous and biomedical systems; (3) therapeutic itineraries in Indigenous and biomedical systems; (4) ideological implications of adding biomedical devices to Indigenous healing systems; and (5) therapeutic failure in and efficacy of Indigenous and biomedical systems. From a noncolonial perspective and seeking to increase the quality and acceptability of health care for the Indigenous populations of the Brazilian Amazon, the training of Indigenous health professionals presents itself as a promising strategy. For this goal, universities should serve as empowering settings for Indigenous health students that support them in their growth and development, raise their awareness of injustice, and catalyze change toward a culturally adapted and effective service for the users. [ABSTRACT FROM AUTHOR]

Snake Awareness Rescue Protection App (SARPA) is a digital platform used in Kerala, India, to prevent snakebites. SARPA connects users with local snake rescuers who are on hand to safely bag and translocate snakes that enter homes. This article reflects on the 'doing' of digital ecologies while researching SARPA, narrating my fieldwork and collaboration with SARPA's developers to show how my research supported the platform's design and implementation. Through this reflection, I demonstrate how collaboration with software designers and developers may provide a means for cultural geographers to put their scholarship into practice, enabling them to contribute to improving the usability, accessibility or environmental sustainability of digital technologies. [ABSTRACT FROM AUTHOR]

In Brazil, around 80% of snakebites are caused by snakes of the genus Bothrops. A three-dimensional culture model was standardized and used to perform treatments with Bothrops erythromelas venom (BeV) and its antivenom (AV). The MRC-5 and L929 cell lines were cultured at increasing cell densities. Morphometric parameters were evaluated through images obtained from an inverted microscope: solidity, circularity, and Feret diameter. L929 microtissues (MT) showed better morphometric data, and thus they were used for further analysis. MT viability was assessed using the acridine orange and ethidium bromide staining method, which showed viable cells in the MT on days 5, 7, and 10 of cultivation. Histochemical and histological analyses were performed, including hematoxylin/eosin staining, which showed a good structure of the spheroids. Alcian blue staining revealed the presence of acid proteoglycans. Immunohistochemical analysis with ki-67 showed different patterns of cell proliferation. The MT were also subjected to pharmacological tests using the BeV, in the presence or absence of its AV. The results showed that the venom was not cytotoxic, but it caused morphological changes. The MT showed cell detachment, losing their structure. The antivenom was able to partially prevent the venom activities. [ABSTRACT FROM AUTHOR]

Aim: To study the safety profile and effectiveness of Anti Snake venom (ASV) in western India Methods: This retrospective study gathered safety, and clinicoepidemiologicaldata on 157 patients admitted at Shri Sainath Hospital, Dharampur, Gujarat, from July 2022 to February 2023. Results: Majority were bitten between August and November. There were 88 males, 5 to70 yrs. (mean 39.14), 69 females, 2 to 70 years (mean 40.32). 6 of these were children ranging from 2 to 12 years.134 were agricultural labourers. 120 cases were analysable. 17 had neurotoxicity and 103 had haemotoxicity. Mean (SD) number of vials used was 10.1(6.2), time to discontinue ASV was 3.0(5.2) hours, and duration of hospital stay was 4.5(2.6) days. Patients bitten by saw scaled vipers were discharged early. In Russel’s Viper bites, number of vials used, was higher if the bite to needle time was less than 6 hours 9 patients suffered 24 adverse events, with two possible cases of anaphylaxis. One case had urticaria, itching and tachycardia as a triad. The remaining were isolated events of mild urticaria, itching, tachycardia, hypotension, cough, rigor. Conclusion: 10.1 vials were needed on average for control of envenomation with no fatalities or severe comorbidities. Adverse events were reported in 5.7% cases. The ASV brand used was well tolerated. Patients who were brought late suffered more renal complications [ABSTRACT FROM AUTHOR]

Background Snake venom is a complex mixture of organic and inorganic constituents, including proteins and peptides. Several studies showed that antivenom efficacy differs due to intra- and inter-species venom variation. Methods In the current study, comparative functional characterization of major enzymatic proteins present in Craspedocephalus malabaricus and Daboia russelii venom was investigated through various in vitro and immunological cross-reactivity assays. Results The enzymatic assays revealed that hyaluronidase and phospholipase A2 activities were markedly higher in D. russelii. By contrast, fibrinogenolytic, fibrin clotting and L-amino acid oxidase activities were higher in C. malabaricus venom. ELISA results suggested that all the antivenoms had lower binding potential towards C. malabaricus venom. For D. russelii venom, the endpoint titration value was observed at 1:72 900 for all the antivenoms. In the case of C. malabaricus venom, the endpoint titration value was 1:2700, except for Biological E (1:8100). All these results, along with the avidity assays, indicate the strength of venom–antivenom interactions. Similarly, the western blot results suggest that all the antivenoms showed varied efficacies in binding and detecting the venom antigenic epitopes in both species. Conclusions The results highlight the need for species-specific antivenom to better manage snakebite victims. [ABSTRACT FROM AUTHOR]

Cerebral sinus venous thrombosis (CSVT) is an uncommon and potentially life-threatening neurological disorder that is often missed because its clinical and radiological symptoms are not specific. Snake bites are a rare cause of cerebral venous sinus thrombosis that must be recognized and treated promptly to improve survival. Here, we present a case of a 30-year-old male patient who had cerebral venous thrombosis after snake bite in the rural area of southern Somalia. After close monitoring with anticoagulation, the condition of the patient improved and discharged from the hospital with full of consciousness. There are only a few cases reported in the literature of snake bites causing cerebral venous thrombosis. [ABSTRACT FROM AUTHOR]

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Snake bites are a global health hazard and are a noteworthy cause of mortality and morbidity especially in Southeast Asia. Cerebral complications after snake bite are rare. It can be attributed to various factors such as vasculitis, vasospasm, endothelial damage; toxin-induced procoagulant effect, and disseminated intravascular coagulation. We present a case of a previously healthy 22-year-old woman who suffered acute multiple cerebral infarctions following Russell's viper bite. Imaging revealed significant non-hemorrhagic infarctions in the left middle cerebral artery territory and right pons, indicating rare yet severe neurological complications of viper envenomation. The patient experienced serious complications including rhabdomyolysis and acute kidney injury, ultimately leading to her demise due to aspiration pneumonia and septic shock. This case underscores the potential neurological impact of viper envenomation and underscores the challenges in managing delayed procoagulant effects of snake venom, despite the administration of anti-snake venom. Early detection and intervention remain vital in addressing such devastating outcomes. [ABSTRACT FROM AUTHOR]

Audience: Clerkship-level medical students, sub-interns, junior and senior residents, attending physicians Introduction: Bite injuries and envenomation are core content found in the model of the clinical practice of emergency medicine.1 However, depending on the geographic location of training or clinical practice, physicians may or may not be exposed to these pathologies. For example, a qualitative analysis conducted in 2022 discovered a significant range in emergency medicine (EM) physician perception of snake antivenom use and level of comfort, noting that experiences with its use ranged from hundreds of cases treated to purely didactic understanding.2 Such discrepancies necessitate supplemental education and activities to bridge the knowledge gap. Ideally, these activities would utilize tenets of experiential learning to allow learner processing comparable to that of clinical experience.3 Flipped classroom and audience participation promote engagement and active learning when compared to the passive learning of lectures.4 In that vein, there is a growing body of gamified resources in medical education which utilize pattern recognition and problem solving skills that can be analogous to clinical practice.5,6 Educational Objectives: By the end of this activity, learners will be able to: 1) identify and name species responsible for bite/sting/envenomation injuries, 2) recognize associated signs, symptoms, physical exam findings and complications associated with bites/stings/envenomations by certain species, 3) discuss management such as antibiotics, antivenom, and supportive care. Educational Methods: We designed a small group activity asking residents to identify, research, and present the "culprits" implicated in environmental exposures to animals and insects, and match them to corresponding clinical scenarios. Research Methods: Participants anonymously answered electronic multiple-choice quizzes before and after completing the activity to gauge its effectiveness in conveying the material. They also completed an additional anonymous, electronic survey regarding their attitudes towards this activity and the possibility of other gamified didactics within the curriculum. Results: Each resident class showed an upward trend in their average multiple-choice score, the greatest of which was seen in the post-graduate year (PGY) 1 class. The residency demonstrated a statistically significant improvement in their ability to answer multiple choice questions (MCQs), with an average preactivity score of 67.14%, and post-activity score of 87.14%. Participants showed determination and enthusiasm to engage with the material when presented in a gamified format, and 100% of post-activity survey respondents wanted to participate in further gamified activities. Discussion: Gamified small group activities are a fun and effective method of supplementing residency and medical student education for both common and esoteric clinical presentations that they may not encounter in the clinical environment. [ABSTRACT FROM AUTHOR]

Andrographis alata (Vahl) Nees (Acanthaceae) is commonly termed the vernacular name Peria nangai, comes under most undershrub moist deciduous forest with grassland habit and habitat. It is a medicinal plant form the backbone of traditional system of medicine in India. An important unnoticed medicinal plant found in our hedge grows is Andrographis alata. A. alata is a lesser-known species compared to its widely studied counterpart, Andrographis paniculata. The origin of the crop is India and Sri Lanka. A plant is referred to be medicinal plant if any part of the plant or its products is used to treat any ailments or prevent or cure a disease or alter any physiological and pathological processes. The plant A. alata parts and the extract from this it is been used by locals for many years. It has garnered attention in traditional medicine systems for its potential therapeutic properties. An important phytocomponent present in the plant are andrographolide and neo andrographolide which have anti-viral, antioxidant, anti-inflammatory, anti-malarial and hepatoprotective properties. The plant is also been used by locals to treat snake bites and jaundice. But these properties are not scientifically proven. The future prospects of A. alata depend on continued scientific interest, investment in research and development, conservation efforts, and its acceptance within healthcare systems and markets. The purpose of this review paper is to describe the various aspects of Andrographis alata (Vahl) nees botanical description, medicinal values, chemical constituents, phytochemistry, pharmacological properties, biological activities and cultural practices. [ABSTRACT FROM AUTHOR]

Background: Snakebite statistics in Sudan are lacking despite the high estimated burden of the problem. One study in Sudan reported the presence of 17 medically significant snakes belonging to three major families: Burrowing asps, Elapidae, and Viperidae. These snakes usually become abundant during and after the rainy season, and most snakebite victims are farm workers. This study was set out based on the observed snakebite management, poor outcomes and lack of information on the healthcare provider's knowledge of this serious, deadly medical and health condition in snakebite-endemic regions of Sudan. Materials and methods: In August 2022, a descriptive cross-sectional survey was conducted involving 394 medical and healthcare providers in snakebite-endemic regions of Sudan (Gaddarif, Sinnar, Khartoum, and Kassala). A validated questionnaire was used. It consisted of seven sections addressing the study population demographic characteristics, knowledge of snakes, snakebites, and their management. Data analysis used various statistical tests using Microsoft Excel and the Statistical Package for Social Sciences (SPSS) version 20 (IBM SPSS Inc., Chicago, IL) was done. Results: Among the 394 participants (44.7% males, 53.3% females), 58.1% demonstrated adequate knowledge of snakes, and 45.3% exhibited adequate knowledge of snakebites. A mere 25.9% received training in snakebite management, with 60.4% possessing adequate knowledge in this domain. Only 14% expressed high confidence in managing snakebites, and 40.9% reported having protocols for snakebite management at their health facilities. Conclusion: The study highlighted the inadequacy of healthcare providers' knowledge in snakebite-endemic areas in Sudan regarding snakes, snakebites and snakebites management. Urgent interventions, such as intensive continuing professional education and training, are essential to address this neglected medical and health problem. [ABSTRACT FROM AUTHOR]

Background: Human-snake conflicts are common worldwide, often resulting in snakebites. Snakebite envenoming causes over 125,000 deaths and 400,000 permanent disabilities worldwide every year. India alone accounts for an average of ~58,000 annual snakebite-induced deaths. As human developments rapidly expand into suburban and rural areas, snakes are being displaced and incidences of residents finding snakes within their dwellings are increasing. Most people have an innate fear of snakes, compounded by centuries of negative influence from culture and mythology manifesting in people often attempting to kill snakes. Snake rescuers are volunteers who remove and relocate snakes to safe areas. This is a risky job that poses potentially fatal implications if bitten. These volunteers mostly receive no financial compensation for their time or transportation costs, but they choose to do it for their love of snakes, conservation, and for the altruistic nature of helping others. Snake rescuers often receive no formal training and are unfunded resulting in removing snakes improperly without adequate safety equipment or the required skill set to safely complete the task. Therefore, it is critical to determine their challenges and requirements to promote the safe rescue of snakes while protecting human lives. Methodology/Principal findings: In this study, we developed an online questionnaire and interviewed 152 snake rescuers in Tamil Nadu, India following written informed consent to determine their challenges and needs for rescuing snakes safely. The results demonstrate that most rescuers are males, and they conduct snake rescues for varying lengths of time. They mostly receive no formal training and are bitten by snakes. They spend their own money on the purchase of snake-handling equipment and on treatments if bitten or injured during a rescue. Conclusions/Significance: The rescuers highlighted the urgent need for formal training, safety equipment and standard protocols for rescuing snakes in Tamil Nadu. Overall, this study demonstrates that snake rescuing should be appropriately regulated by the authorities, in particular the Wildlife Division of State Forest Departments in India, and formal training along with necessary equipment, medical insurance and appropriate recognition should be provided to them to safely remove snakes from human dwellings and manage the safety of both snakes and humans. They can also act as educators to disseminate information about the preventive and first aid measures for snakebites as well as the ecological importance of snakes. Author summary: Snakebite envenoming is a high-priority neglected tropical disease that largely affects poor, rural communities living in developing countries. Human-snake conflicts are a key trigger for snakebites, and they occur mainly due to urbanisation and the rise in pest populations leads to the migration of snakes into human-dominated environments. The removal of snakes and release of them into safe habitats is critical in mitigating the snakebite crisis and saving snakes. Snake rescuers play important roles in saving snakes and humans by safely removing snakes and often educating communities about the dangers of snakes and appropriate dos and don'ts for snakebites. However, they face numerous challenges in rescuing snakes and most of their issues have not been brought to the attention of relevant authorities. In this study, we interviewed 152 snake rescuers in Tamil Nadu and highlighted their experiences, challenges and requirements in performing this task. The data demonstrate that most rescuers need certified training, recognition and identity cards from the government authorities, financial support for purchasing snake handling equipment and medical insurance for treatments if bitten by snakes and encouragement for them to be educators for snake conservation and snakebite mitigation. This study highlights the key challenges in rescuing snakes and appropriate recommendations to promote the safe rescue of snakes and the peaceful coexistence of snakes and humans. [ABSTRACT FROM AUTHOR]

Snakebite envenoming (SBE) is a neglected tropical disease that disproportionately affects underprivileged communities in the Tropics. India is particularly affected by SBE, with an estimated 58,000 deaths each year. The Indian Council of Medical Research (ICMR) has designated the Amrita Institute of Medical Sciences (AIMS) as a Collaborating Centre of Excellence (CCoE) for snakebite. The CCoE aims to generate evidence, coordinate research, and serve as a knowledge partner for the prevention and control of SBE. The CCoE will address various aspects of SBE, including anti-snake venom, venom research, healthcare system and delivery, policy advocacy, research, preventive measures, and a one-health approach. The challenges ahead include bringing stakeholders together and contextualizing information for diverse needs. The funding for the CCoE will be project-based, and the CCoE will align its activities with the WHO's goal of reducing SBE mortality by 50% by 2030. [Extracted from the article]

In 2009, the World Health Organization included snakebite on the list of neglected tropical diseases, acknowledging it as a common occupational hazard for farmers, plantation workers, and others, causing tens of thousands of deaths and chronic physical disabilities every year. This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims. These recommendations are based on clinical experience and clinical research evidence. This guideline focuses on the following topics: snake venom, clinical manifestations, auxiliary examination, diagnosis, treatments, and prevention. [ABSTRACT FROM AUTHOR]

Unlike the well-documented bothropic and crotalid snakebites in Brazil, lachetic envenomings (i.e., triggered by the bushmaster snake) are rare and present significant diagnostic challenges. This case describes a severe envenoming induced by a Lachesis muta snake in a 26-year-old Brazilian man who was bitten near a forest in November 2022. Characteristic symptoms such as sweating and bradycardia pointed towards lachetic envenoming, but initial misdiagnosis as a bothropic bite resulted in a delay in appropriate antivenom therapy. Despite later receiving the correct treatment, the severity of the envenoming necessitated the amputation of a finger and triggered a severe infection. This report highlights the challenges of diagnosing and treating Lachesis spp. bites due to their rarity. Moreover, an overview of lachetic-induced signs and symptoms was explored. This study emphasizes that further reports are warranted to improve understanding of Lachesis muta envenoming and to optimize treatment strategies. [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]

Introduction: In 2023, a group of experts proposed that a definition of major bleeding in pharmaceutically anticoagulated patients be used in all snakebite trials. This includes bleeding that results in death, is life-threatening, causes chronic sequelae, or consumes major healthcare resources, including bleeding into a major area or hemoglobin concentration decrease ≥20 g/L. We hypothesized that a decline in hemoglobin concentration ≥20 g/L is common but rarely clinically significant in our population of Arizona rattlesnake bite patients. Methods: Poison center records of rattlesnake bites in humans from 2018 through 2022 were retrospectively reviewed and assessed for major bleeding by the above criteria. Results: Four hundred and eighty-one patients met the inclusion criteria, of whom 265 (55.1%) had a hemoglobin concentration decrease ≥20 g/L. No patients died, and there was no evidence of bleeding into a critical organ. Three patients (1.1%) received blood transfusions. A decrease in hemoglobin concentration ≥20 g/L was 100% sensitive for identifying the major bleeding-associated outcomes; however, specificity was only 45.2%. Measures of healthcare utilization and chronic sequelae were somewhat higher in patients with a decrease in hemoglobin concentration ≥20 g/L. Discussion: Laboratory manifestations of hemotoxicity were common in this population, but hemorrhage was rare. While over half of patients met the major bleeding criterion of a decline in hemoglobin concentration ≥20 g/L, only 1.1% had bleeding that was potentially life-threatening as measured by receipt of a red blood cell transfusion. None died or had bleeding into a critical area. While nonspecific for major bleeding, a drop in hemoglobin concentration correlated with worse envenomation severity: these patients received more vials of antivenom, had a higher medical bill, a longer hospital stay, and were less likely to report full recovery at 90 days. Conclusions: A decrease in hemoglobin concentration ≥20 g/L should not be used as evidence of major bleeding for Arizona rattlesnake envenomation studies, but it may have a role as an indirect marker of envenomation severity. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Cardiovascular Disease Research, discusses the importance of early surgical intervention in snake bites, which are a significant problem in India. The study aims to identify indicators for early surgery and develop guidelines for surgical intervention in snake bite cases. The study found that early fasciotomy, a surgical procedure, can prevent compartment syndrome and limb loss in snakebite patients. The authors recommend early fasciotomy as a preventive measure and emphasize the importance of local and systemic care for snakebite patients. [Extracted from the article]