جستجوی مقالات مرتبط با کلیدواژه « snake bites » در نشریات گروه « پزشکی »

Snakebite is a potentially life-threatening emergency that can be treated effectively. Snake envenomation can cause hematologic and coagulation abnormalities. In this respect, tests such as prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) are commonly used. The present study aimed to determine the value of coagulation parameters in the prognostication of snakebite patients.

This prospective descriptive observational study examined the coagulation parameters, including PT, INR, and aPTT, in consecutive cases of snake envenomation admitted to a tertiary health care hospital from October 2019 to August 2021. The correlation of coagulation parameters with each other and with prognostic indicators (ie, the number of days spent in the intensive care unit [ICU], the requirement of anti-snake venom [ASV], fresh frozen plasma [FFP], and the total number of blood products) was studied.

A total of 58 patients with snakebite were studied. The majority were males (69%). The highest proportion of patients belonged to the age group of 16-40 years (60%). The correlation of coagulation parameters with each other was statistically significant. The correlation of coagulation parameters with prognostic indicators (ie, the total number of ASV vials administered, the total number of days in the ICU, the total number of FFP units administered, and the total number of blood components administered) was statistically significant.

Coagulation parameters (PT, INR, and aPTT) are essential laboratory investigations for treatment monitoring and can be used effectively for the prognostication of snakebite patients. In cases where the coagulation profile of snakebite patients shows abnormalities, conducting repeated coagulation studies at intervals of 12 hours can contribute to improved prognostication.

Despite sharing common evolutionary features, Viperidae species including Echis carinatus and Macrovipera lebetina possess venoms with different proportions of toxic agents, thereby causing clinical effects with potentially variable severity. This study was an effort to differentiate the clinical effects and outcomes of E. c. sochureki and M. l. obtusa victims.   

In this prospective cross-sectional study, snakebite patients treated at a reference poisoning center in northeast of Iran in 2012 were enrolled. The features of snakebite event, demographic and clinical data of patients were recorded in checklists.

Twenty-seven patients (63% male) with mean age of 34.8 ± 18.1 years were included. The offending snakes were recorded as "E. c. sochureki" in 63%, "M. l. obtusa" in 25.9% and "unknown" in 11.1% of cases. The most common clinical findings were fang mark in 100%, local pain in 81.5% and local edema in 74% of patients. Although the victims of both species showed classic features of viper envenoming syndrome including marked local effect and hemostatic disturbances, the victims of M. l. obtusa had significantly higher creatine kinase levels (P = 0.031) and lower platelet counts (P = 0.043), whereas marked edema (> 15cm) was significantly more common in E. c. sochureki victims (P = 0.028). Envenomation severity, other clinical effects and outcomes did not differ between the two species. Patients with delayed presentation to hospital had greater envenomation severity and edema extent and higher rate of coagulopathy.

Species-specific description of clinical effects following snakebite envenoming is useful for syndromic approach to human victims. The clinical envenoming syndromes by E. c. sochureki and M. l. obtusa show many common similarities despite the difference in severity of some effects. The delay in hospital admission and antivenom therapy is a risk for increased severity of envenomation and development of poorer clinical outcomes.

Snake antivenom (SAV) is the definitive treatment for snake envenomation. But SAVs are specific, expensive and limited in supply. SAVs also come with risk of adverse reactions. Hence, this study was conducted to assess the use of SAV, adverse reactions to SAV and its clinical outcomes in snakebite patients. This was a retrospective study. Medical records of snakebite patients for the period from January 2014 to September 2017 were reviewed and study data was extracted. Clinical outcomes were measured by mortality rate in those receiving SAV. Among 165 subjects, only 9 patients (5%) were treated with SAV after presenting with envenomation symptoms in which five cases with identified snakes were given monovalent SAV namely pit viper (two cases), king cobra, sea snake and cobra with one case each. Meanwhile, three cases of unidentified snake received polyvalent SAV and one case received pit viper SAV. Most of the patients (8/9, 88.9%) received SAV within 24 hours after snakebite. The average time gap to first administration was 7.23 hours. In patients receiving SAV, six out of 9 cases required two to four vials of SAV. All the patients receiving SAV did not encounter any adverse effects except a child who had pyrogenic reaction. All patients survived without significant morbidity at discharge. The total cost of SAV for the 9 patients was US$ 24,082.68. From this study, the incidence of snakebites requiring SAV was low. Low incidence of adverse effects and no mortality were observed in patients receiving SAV.

Snakebite is a medical emergency and must receive high-priority assessment and treatment, even in patients who initially appear well. A few reports have been published regarding snakebite in Iran. This study aimed to assess the snakebite cases in a tertiary teaching hospital in the northwest of Iran. We assessed demographic and clinical characteristics of adult patients who were admitted because of snakebite into Ayatollah Taleghani Teaching Hospital, Urmia, West Azerbaijan, Iran, between January 1, 2012, and December 31, 2014. After institutional Ethics Committee approval, the required data were extracted, analyzed, and reported. Totally, 60 snakebite cases were recorded during three years study period, of them 63.3% were male. The patients’ Mean±SD age was 37.8±15.8 years. The majority of snake envenomations occurred in the farms and mountains (71.4%), frequently in the afternoons of spring and summer seasons, and mostly affected inhabitants or visitors of the rural areas. The Mean±SD time interval between snake envenomation and admission to the first health center was 15.3±28.6 hours. The anatomic sites of the snakebite were lower and upper extremities in most instances (96.6%). Only 5 (8.3%) patients had severe toxicity, and 2 patients underwent surgical fasciotomy. The patients were treated using antihistamines (n=45), corticosteroids (n=35), antibiotics (n=54), polyvalent snake antivenins (n=50), wound care and tetanus immunization (n=39). The Mean±SD number of polyvalent snake antivenins used for each patient was 3.3±1.9 (range, 1-8) vials. There was no in-hospital fatality. Most snakebites victims in the northwest of Iran were men in their productive age. Early diagnosis and proper use of snake antivenins could be life-saving and should be encouraged.

bite affects about 2 million people every year, with more than 100000 mortalities annually. A person bitten by a snake represents a variety of symptoms. Snake bite might be asymptomatic or with mild local symptoms or even could lead to tissue damage and rapid death. This study aimed to investigate characteristics of snake bite in Northwest Iran.
In this retrospective study, medical records of all patients with final diagnosis of snake bite who were admitted to Sina Clinical-Educational Center, the referral center for envenomation in Northwest Iran were investigated from 2002 to 2012. Demographic information and laboratory findings were collected using a checklist.
During a 10 year period, 160 individuals with snake bite were admitted, of which 128 (77.6%) were male. With regard to occupation, farmers accounted for the largest portion (n = 57, 34.6%). The most prevalent sites bitten by snakes were right hand (25.5%) and left leg (24.8%). Fifty-seven patients (34.5%) had leukocytosis and four (2.4%) had coagulopathy. Pain and swelling were two main complaints, with vomiting, dizziness, and tingling in extremities coming afterwards.
Because snake bite is one of the most important emergencies presenting to emergency department and Iran’s geographic status bears wide spectrum of poisonous snakes, this study was performed to further explore the clinical and epidemiologic details of snake bite.

The global incidence of snakebite has become a major concern to the community. This study aimed to evaluate the effect of mango seed kernel methanol extract on metalloproteases in Carpet Viper (Echis ocellatus) venom.
Mango seed kernel methanolic extract was evaluated in vitro for its anti-venom activity and inhibition of metalloproteases of Carpet Viper's (Echis ocellatus) venom. Metalloprotease portion was partially purified from the venom of E. ocellatus with a yield of 71%, a purification fold of 2.63 and a specific activity of 19.00 µmol/min/mg protein.
The enzyme appeared as a band on SDS-PAGE with a molecular weight of 23 kDa. The kinetic properties of the enzyme showed a Km of 0.31 mg mL-1 and a Vmax of 9.09 µmol min-1. When the enzyme was incubated with the extract, kinetic studies revealed a mixed non-competitive pattern of inhibition with Km values of 0.56 and 1.11 mg mL-1 and Vmaxvalues of 6.67 and 4.17-µmol min-1 for 5% and 20% inhibitor concentrations, respectively. An estimated Ki value of 0.168 mg mL-1 was obtained from a secondary plot demonstrating that the extract had a high affinity for the partially purified enzyme; thus, could serve as an effective inhibitor.
Methanol extract of mango seed kernel has a high affinity for the partially purified enzyme, and it might provide an inexpensive and readily available alternative to sheep serum in the management of snakebite envenomation. Therefore, further in vivo studies are necessary to assess its effectiveness and safety.

Snakebite is a serious public health problem in the world. The annual incidence of snakebites ranges from 4.5-9.1 in 100,000 population in Iran. With regard to diversity of envenomation profiles in different geographical parts of Iran, the aim of this study was to determine the demographical data, clinical and laboratory findings, and the outcome of the snakebite victims referred to a tertiary referral hospital.
In this retrospective, cross-sectional study in Loghman Hakim Hospital Poisoning Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, during a four-year period from March 2007 to March 2011. The demographic data, clinical manifestations, paraclinical findings, treatments performed before hospital admission, time elapsed between the bite and hospital admission, total dose of antivenom and the patients’ outcomes were investigated.
Seventy cases (58 males, 12 females) were evaluated. Most of the cases (79%) were older than 20 year old. The most common bite site was upper extremity (67%). Most of the patients were admitted within 5 h after the snakebite. The most common local and systemic manifestations were swelling (90%), pain (81.4%), nausea and vomiting (24.3%). Leukocytosis (35.7%) and thrombocytopenia (25.7%) were the most common laboratory abnormalities. Most of the patients (97.1%) were treated with antivenom. Fifty percent of the patients only received 3-5 vials of antivenom. The mortality rate was 1.4%. Necrosis of the toes and compartment syndrome were the only serious complications.
The findings emphasize the importance of early admission to the hospital and treatment with antivenom to avoid morbidity and mortality

Bungarus caeruleus (common krait) bite during monsoon season is common in northwest India. Respiratory failure is responsible for high mortality in the victims. In this study we report our experience with manual ventilation using bag valve mask (BVM) in patients with neuroparalysis due to common krait bite. This prospective study was conducted between June 2009 and December 2009. All consecutive patients with diagnosis of common krait bite who were manually ventilated by BVM were studied. The duration of ventilation and complications associated with ventilation were noted. Polyvalent anti snake venom was administered as per the «national snake bite protocol» and patients were followed up until final outcome. Thirty-four patients (70. 6% men) were studied. All patients except two came from rural areas and they were hospitalized between June and September. Majority of patients were bitten during the night while sleeping on the floor. The mean time interval between bite and arrival to hospital was 4. 4 hours. Ptosis (100%) was he most common clinical finding followed by ophtalmoplegia (80%) and limb muscle weakness (74%). Twenty-four patients (70%) developed respiratory symptoms and 20 (59%) were intubated and manually ventilated by BVM. Mean duration of assisted ventilation was 34. 6 ± 12. 8 hours. Hoarseness of voice and throat pain were noted in all intubated patients following extubation, which responded to conservative therapeutic measures. The mean duration of hospitalization was 6 ± 1. 6 days. All patients except one survived. Manual ventilation with BVM in patients with neuroparalysis due to common krait bite is a safe and effective modality in resource constraint settings.