Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims

Abstract Background: Twenty-minute whole blood clotting test (20WBCT) and Modified Lee and White (MLW) method are the most routinely employed bedside tests for detecting coagulopathic snake envenomation. Our study compared the diagnostic utility of MLW and 20WBCT for snakebite victims at a tertiary care hospital in Central Kerala, South India. Methods: This single-center study recruited 267 patients admitted with snake bites. 20WBCT and MLW were performed simultaneously at admission along with the measurement of Prothrombin Time (PT). The diagnostic utility of 20WBCT and MLW was determined by comparing the sensitivity (Sn), specificity (Sp), positive and negative predictive values, likelihood ratios, and accuracy at admission with an INR value > 1.4. Results: Out of 267 patients, 20 (7.5%) patients had VICC. Amongst those who had venom-induced consumption coagulopathy (VICC), MLW was prolonged for 17 patients, (Sn 85% 95% confidence interval [CI]: 61.1-96.0) whereas 20WBCT was abnormal for 11 patients (Sn 55%, 95% CI: 32.04-76.17). MLW and 20WBCT were falsely positive for the same patient (Sp 99.6%, 95% CI: 97.4-99.9%). Conclusion: MLW is more sensitive than 20WBCT to detect coagulopathy at the bedside amongst snakebite victims. However, further studies are necessary for standardizing bedside coagulation tests in snakebite cases.

Bothrops envenomation in dogs: local and systemic manifestations

Background: Snakebite envenoming is a condition that affects humans and domestic animals worldwide. Identification of the snake species involved in the envenomation is infrequent. Bothrops envenomation presents typical clinicopathological features. This report describes epidemiological, clinical, and pathological data of 2 cases of Bothrops envenomation in dogs, including the first case of Bothrops moojeni snake striking a domestic animal in Brazil. Cases: Case 1. A dog was witnessed to have a Bothrops moojeni snakebite on a farm. In the first 24 h, acute lameness, pain, diffuse swelling, focal bleeding at the left forelimb, and increased whole-blood clotting time were observed in the envenomed dog. Polyvalent antivenom was administered in addition to fluid therapy, analgesics, corticosteroids, and antibiotics. On the 5th day, the animal presented spontaneous bleeding at the wound site, thrombocytopenia, and increased whole-blood clotting time. An additional dose of polyvalent antivenom was administered, and local treatment at the snakebite site was initiated. After 13 days, the dog showed no clinical or laboratory changes and recovered entirely. Case 2. A mongrel dog was taken for a necropsy to determine the cause of death. Grossly, major findings included swelling in the nasal plane that extended to the neck and dissecting hemorrhage in the subcutaneous tissue and adjacent musculature. Hemorrhages were observed in the heart, parietal pleura, left forelimb, lumbar region, and perirenal tissue. Marked necrosis and disruption of small blood vessels and lymphatics within the deep dermis and subcutaneous tissue were the main microscopic findings close to the snakebite site. Additionally, degeneration and necrosis of muscle fibers and dissecting hemorrhage were observed in the head and neck tissues surrounding the snakebite site. Kidneys showed marked interstitial hemorrhage and acute tubular nephrosis. Discussion: Bothrops envenoming is characterized by local (hemorrhage, dermonecrosis, and myonecrosis) and systemic (coagulative disorders, systemic hemorrhage, and acute kidney injury) changes due to the effect of the main venom components such as phospholipase A2 and metalloproteinases. These changes are hallmarks for the bothropic envenomation, supporting the diagnosis in cases 1 and 2. In case 1, the dog developed a Bothrops moojeni snakebite envenomation, but the immediate treatment with antivenom allowed a favorable outcome. In case 2, gross and microscopic findings supported the presumptive diagnosis of fatal bothropic envenomation. A marked local reaction such as swelling, pain, bleeding, bruising, and tissue necrosis was observed in case 1. In case 2, the most significant local changes were swelling and edema at the head and neck, hemorrhage in the subcutaneous tissue, and adjacent musculature. Systemic effects were observed clinically as spontaneous bleeding, thrombocytopenia, increased whole-blood clotting time (Case 1), systemic hemorrhages, and acute tubular nephrosis (Case 2). A proper treatment probably prevented the development of acute renal failure in Case 1. Herein, we show the first case of accidental snakebite envenomation by B. moojeni in a dog in Brazil. Information is scarce on the identification of venomous snake species striking domestic animals. Fast detection of well-determined clinical and pathological findings of Bothrops envenomation is essential for a correct diagnosis, therapeutics, and a good prognosis, even in cases with an unknown history.

Spontaneous poisoning by Dodonaea viscosa (Sapindaceae) in cattle in Southern Brazil / Intoxicação espontânea por Dodonaea viscosa (Sapindaceae) em bovinos no sul do Brasil

In this study, an outbreak of spontaneous poisoning by Dodonaea viscosa (D. viscosa) in a herd of dairy cattle in the municipality of Capão do Leão, Rio Grande do Sul, was investigated. Three deaths occurred in a batch of 16 Jersey cattle, aged between three and four years, kept in a native field. The clinical signs observed were apathy, decreased production, and anorexia, with death occurring within approximately 48 h after the onset of signs. The three cattle were necropsied, and tissue samples were sent for histopathological examination. Necropsy findings included serosanguineous fluid in the abdominal cavity, intestines with congested serosa, and marked mesenteric edema. The mucosa of the abomasum of two of the animals was hemorrhagic with bloody content, and among the ruminal content of a bovine, leaves with morphological characteristics compatible with D. viscosa were observed. The livers of the three animals were enlarged, with accentuation of the lobular pattern. Histologically, centrilobular coagulation necrosis with congestion and hemorrhage was observed in the liver. Vacuolization and degeneration of hepatocytes were observed in the mid-zonal and periportal regions. The diagnosis of poisoning by D. viscosa leaves was based on epidemiological data, necropsy findings, and histopathological alterations. The presence of the plant in the rumen and in the grazing site of the affected cattle was essential for the diagnosis.(AU)

Neste trabalho, é descrito um surto de intoxicação espontânea por Dodonaea viscosa (D. viscosa) ocorrido em um rebanho de bovinos leiteiros, no município de Capão do Leão, no Rio Grande do Sul. Ocorreram três mortes em um lote de 16 bovinos da raça Jersey com idades entre três e quatro anos, mantidos em campo nativo. Os sinais clínicos observados foram apatia, queda na produção e anorexia, com morte em aproximadamente 48 horas após o início dos sinais. Os três bovinos foram necropsiados, e amostras de tecidos foram encaminhadas para exame histopatológico. Os achados de necropsia incluíam líquido serossanguinolento na cavidade abdominal, intestinos com serosas congestas e marcado edema de mesentério. A mucosa do abomaso de dois animais apresentava-se hemorrágica com conteúdo sanguinolento e, em meio ao conteúdo ruminal de um bovino foram observadas folhas com caracteres morfológicos compatíveis com D. viscosa. O fígado dos três animais estava aumentado, com acentuação do padrão lobular. Histologicamente no fígado havia necrose de coagulação centrolobular com congestão e hemorragia. Nas regiões médio-zonal e periportal observou-se vacuolização e degeneração dos hepatócitos. O diagnóstico de intoxicação pelas folhas D. viscosa foi baseado nos dados epidemiológicos, nos achados de necropsia e nas alterações histopatológicas. A presença da planta no rúmen e no local de pastoreio dos bovinos afetados foi fundamental para o diagnóstico.(AU)

Spontaneous poisoning by Dodonaea viscosa (Sapindaceae) in cattle in Southern Brazil / Intoxicação espontânea por Dodonaea viscosa (Sapindaceae) em bovinos no sul do Brasil

In this study, an outbreak of spontaneous poisoning by Dodonaea viscosa (D. viscosa) in a herd of dairy cattle in the municipality of Capão do Leão, Rio Grande do Sul, was investigated. Three deaths occurred in a batch of 16 Jersey cattle, aged between three and four years, kept in a native field. The clinical signs observed were apathy, decreased production, and anorexia, with death occurring within approximately 48 h after the onset of signs. The three cattle were necropsied, and tissue samples were sent for histopathological examination. Necropsy findings included serosanguineous fluid in the abdominal cavity, intestines with congested serosa, and marked mesenteric edema. The mucosa of the abomasum of two of the animals was hemorrhagic with bloody content, and among the ruminal content of a bovine, leaves with morphological characteristics compatible with D. viscosa were observed. The livers of the three animals were enlarged, with accentuation of the lobular pattern. Histologically, centrilobular coagulation necrosis with congestion and hemorrhage was observed in the liver. Vacuolization and degeneration of hepatocytes were observed in the mid-zonal and periportal regions. The diagnosis of poisoning by D. viscosa leaves was based on epidemiological data, necropsy findings, and histopathological alterations. The presence of the plant in the rumen and in the grazing site of the affected cattle was essential for the diagnosis.(AU)

Neste trabalho, é descrito um surto de intoxicação espontânea por Dodonaea viscosa (D. viscosa) ocorrido em um rebanho de bovinos leiteiros, no município de Capão do Leão, no Rio Grande do Sul. Ocorreram três mortes em um lote de 16 bovinos da raça Jersey com idades entre três e quatro anos, mantidos em campo nativo. Os sinais clínicos observados foram apatia, queda na produção e anorexia, com morte em aproximadamente 48 horas após o início dos sinais. Os três bovinos foram necropsiados, e amostras de tecidos foram encaminhadas para exame histopatológico. Os achados de necropsia incluíam líquido serossanguinolento na cavidade abdominal, intestinos com serosas congestas e marcado edema de mesentério. A mucosa do abomaso de dois animais apresentava-se hemorrágica com conteúdo sanguinolento e, em meio ao conteúdo ruminal de um bovino foram observadas folhas com caracteres morfológicos compatíveis com D. viscosa. O fígado dos três animais estava aumentado, com acentuação do padrão lobular. Histologicamente no fígado havia necrose de coagulação centrolobular com congestão e hemorragia. Nas regiões médio-zonal e periportal observou-se vacuolização e degeneração dos hepatócitos. O diagnóstico de intoxicação pelas folhas D. viscosa foi baseado nos dados epidemiológicos, nos achados de necropsia e nas alterações histopatológicas. A presença da planta no rúmen e no local de pastoreio dos bovinos afetados foi fundamental para o diagnóstico.(AU)

Free-living capybaras (Hydrochoerus hydrochaeris) in an urban area in Brazil: biochemical and hematological parameters

Capybaras have found favorable conditions for survival and reproduction in green urban environments. In recent years, the population of these large rodents has been increasingly abundant in several brazilian cities such as Uberlândia, a municipality of the southeastern region with a Cerrado biome. Capybaras are important in the Brazilian Spotted Fever epidemiological chain, by amplifying infection rates of the vector population. However, knowledge of this host's physiology is scarce. Thus, the aim of this work was to describe hematological and biochemical parameters of free-living capybaras groups in urbanized areas in the city of Uberlândia, Minas Gerais State, Brazil. Capybaras were captured in 4 different locations of Uberlândia city, Minas Gerais state, including 1 Condominium (P1), 1 Private Market Garden (P2), 1 Private Club (P3) and 1 Municipal Park (P4). The animals were baited into an octagonal iron corral and chemically contained with anesthetic darts. After sedated, blood was collected from the femoral vein in tubes with and without EDTA. Biochemical evaluation, hematological analysis with differential leukocyte counts and search for Dirofilaria sp. were done. The blood count and biochemistry values obtained from animals of different ages, sex and sectors (P1, P2, P3 and P4) were submitted to the Shapiro-Wilk normality test, considering 95% significance. Values that had a normal distribution were subjected to ANOVA tests followed by Student's t-test. Values that did not follow normality were submitted to the Kruskal-Wallis test, to obtain a P-value, with a significance level of 95%. A total of 19 capybaras were captured: 4 in P1, 6 in P2, 4 in P3 and 5 in P4. From the 19 animals, 13 were females (68.42%) and 6 were males (31.57%), 12 adults (63.15%) and 7 juveniles (36.84%). Apart from occasional skin scars and moderate to intense Ambyomma spp. tick infestations, all captured animals were healthy on a broad examination. From 5 animals captured in P4, despite the use of anticoagulant, blood from 4 animals clotted fast. No microfilariae were found in the thick drop test in any of the 19 animals sampled, and in 2 adult female capybaras captured in P1, Kurloff cells were observed. Hematological and biochemical values presented no major differences when comparing sex and age. Nevertheless, differences in liver and kidney profile were observed between the capybara groups, including ALT, alkaline phosphorus, BUN and creatinine. Blood from 4 animals clotted fast, despite the use of EDTA tubes. Blood clotting of samples with anticoagulant in this work could be associated with some physiological features inherent to capybaras. Many attempts were required to obtain enough blood from each individual due to the rapid hemostasis, what come in accordance with reports in literature. Kurloff cells were observed in 2 adult female capybaras captured in P1, which can be found in peripheral blood of female rodents during follicular phase of estrous cycle. Hematological and biochemical values differences in liver enzymes such as ALT and alkaline phosphorus, and kidney profile enzymes including BUN and creatinine could be associated to capture stress or dietetic variation between groups. Despite statistical relevant, the values were still in accordance with other works, although comparisons should be done with caution since various environments exert a diverse array of stimulus upon the animals such as parasitic, infective, stress, nutritional, social and undoubtedly blood parameters mirror them. In conclusion, this work contributes to the standardization of free-living capybaras' physiological parameters in urban areas.(AU)

Role of crotoxin in coagulation: novel insights into anticoagulant mechanisms and impairment of inflammation-induced coagulation

Snake venom phospholipases A2 (svPLA2) are biologically active toxins, capable of triggering and modulating a wide range of biological functions. Among the svPLA2s, crotoxin (CTX) has been in the spotlight of bioprospecting research due to its role in modulating immune response and hemostasis. In the present study, novel anticoagulant mechanisms of CTX, and the modulation of inflammation-induced coagulation were investigated. Methods: CTX anticoagulant activity was evaluated using platelet poor plasma (PPP) and whole blood (WB), and also using isolated coagulation factors and complexes. The toxin modulation of procoagulant and pro-inflammatory effects was evaluated using the expression of tissue factor (TF) and cytokines in lipopolysaccharide (LPS)-treated peripheral blood mononuclear cells (PBMC) and in WB. Results: The results showed that CTX impaired clot formation in both PPP and WB, and was responsible for the inhibition of both intrinsic (TF/factor VIIa) and extrinsic (factor IXa/factor VIIIa) tenase complexes, but not for factor Xa and thrombin alone. In addition, the PLA2 mitigated the prothrombinase complex by modulating the coagulation phospholipid role in the complex. In regards to the inflammation-coagulation cross talk, the toxin was capable of reducing the production of the pro-inflammatory cytokines IL-1β, IL-6 and TNF-α, and was followed by decreased levels of TF and procoagulant activity from LPS-treated PBMC either isolated or in WB. Conclusion: The results obtained in the present study recognize the toxin as a novel medicinal candidate to be applied in inflammatory diseases with coagulation disorders.(AU)

TP, APTT and fibrinogen reference values in healthy beagle breed dogs / Valores de referência de tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA) e fibrinogênio em cães hígidos da raça beagle

Background: Hemostasis is a process of blood coagulation with the function of preventing hemorrhagic processes in the organism. The Coagulation Time (CT), Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Fibrinogen, Thrombin Time (TT), Increased Fibrin Degradation Products (IFDP) and D-Dimers are laboratory tests that can be used to evaluate the coagulation cascade. Objectives: The present study aimed to determine the reference values of PT, APTT and Fibrinogen by semi-automatic methodology with laboratorial kits. Methods:  Blood samples were collected from 22 healthy beagle dogs and immediately centrifuged and citrated plasma stored at -20ºC for posterior analysis. PT, APTT and fibrinogen were measured using commercial kits in a semi-automatic coagulometer by the viscosity detection system.  Results: Mean values obtained were 6.0 ± 7.3 seconds for PT, 8.4 ± 16.9 seconds for APTT, and 10.2 ± 26.4 seconds for Fibrinogen. Conclusion: It is concluded that the values obtained in this work can be used as reference for healthy Beagles.

Introdução: O Tempo de Coagulação (TC), Tempo de protrombina (TP), Tempo de Tromboplastina Parcial Ativada (TTPA), Fibrinogênio, Tempo Trombina (TT), Aumento dos Produtos da Degradação da Fibrina (PDF) e Dímeros-D são testes laboratoriais que podem ser utilizados para avaliação da cascata de coagulação. Objetivo: O presente trabalho teve por objetivo a determinação dos valores de referência do tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA) e Fibrinogênio em cães hígidos da raça Beagle por método semi-automático, com a finalidade de padronização do método semi-automático em determinados animais. Resultados: Os resultados obtidos foram de 6,0 ± 7,3 segundos para TP, 8,4 ± 16,9 segundos para TTPA, e de 10,2 ± 26,4 g/dL para Fibrinogênio. Conclusão: Conclui-se que os valores obtidos nesse trabalho podem ser utilizados como referência para Beagles hígidos.

TP, APTT and fibrinogen reference values in healthy beagle breed dogs / Valores de referência de tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA) e fibrinogênio em cães hígidos da raça beagle

Background: Hemostasis is a process of blood coagulation with the function of preventing hemorrhagic processes in the organism. The Coagulation Time (CT), Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Fibrinogen, Thrombin Time (TT), Increased Fibrin Degradation Products (IFDP) and D-Dimers are laboratory tests that can be used to evaluate the coagulation cascade. Objectives: The present study aimed to determine the reference values of PT, APTT and Fibrinogen by semi-automatic methodology with laboratorial kits. Methods:  Blood samples were collected from 22 healthy beagle dogs and immediately centrifuged and citrated plasma stored at -20ºC for posterior analysis. PT, APTT and fibrinogen were measured using commercial kits in a semi-automatic coagulometer by the viscosity detection system.  Results: Mean values obtained were 6.0 ± 7.3 seconds for PT, 8.4 ± 16.9 seconds for APTT, and 10.2 ± 26.4 seconds for Fibrinogen. Conclusion: It is concluded that the values obtained in this work can be used as reference for healthy Beagles.(AU)

Introdução: O Tempo de Coagulação (TC), Tempo de protrombina (TP), Tempo de Tromboplastina Parcial Ativada (TTPA), Fibrinogênio, Tempo Trombina (TT), Aumento dos Produtos da Degradação da Fibrina (PDF) e Dímeros-D são testes laboratoriais que podem ser utilizados para avaliação da cascata de coagulação. Objetivo: O presente trabalho teve por objetivo a determinação dos valores de referência do tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA) e Fibrinogênio em cães hígidos da raça Beagle por método semi-automático, com a finalidade de padronização do método semi-automático em determinados animais. Resultados: Os resultados obtidos foram de 6,0 ± 7,3 segundos para TP, 8,4 ± 16,9 segundos para TTPA, e de 10,2 ± 26,4 g/dL para Fibrinogênio. Conclusão: Conclui-se que os valores obtidos nesse trabalho podem ser utilizados como referência para Beagles hígidos.(AU)

Evaluation of coagulation parameters in dogs with overweight or obesity

Background: Hemostatic alterations have already been well characterized in humans with body fat excess, being includedin the list of obesity related comorbidities. Overweight and obesity are common in dogs; however, there is little informationabout the blood coagulation parameters in dogs with these conditions. The aim of this study was to compare hematologicaland coagulation parameters between lean dogs and overweight or obese dogs, including platelets count; prothrombin time(PT); activated partial thromboplastin time (aPTT), coagulation time (CT) and plasma fibrinogen concentration.Materials, Methods & Results: A total of 22 dogs (aged 1 to 10 years, neutered) were evaluated, 10 of them presentedideal body condition score (BCS 4-5) and formed the group 1 (control) and 12 were overweight or obese (BCS 7-9) andformed the group 2. The dogs were submitted to clinical evaluation and then to blood collection for the following laboratorytests: blood count (performed on automatic analyzer), quantification...

Evaluation of coagulation parameters in dogs with overweight or obesity

Background: Hemostatic alterations have already been well characterized in humans with body fat excess, being includedin the list of obesity related comorbidities. Overweight and obesity are common in dogs; however, there is little informationabout the blood coagulation parameters in dogs with these conditions. The aim of this study was to compare hematologicaland coagulation parameters between lean dogs and overweight or obese dogs, including platelets count; prothrombin time(PT); activated partial thromboplastin time (aPTT), coagulation time (CT) and plasma fibrinogen concentration.Materials, Methods & Results: A total of 22 dogs (aged 1 to 10 years, neutered) were evaluated, 10 of them presentedideal body condition score (BCS 4-5) and formed the group 1 (control) and 12 were overweight or obese (BCS 7-9) andformed the group 2. The dogs were submitted to clinical evaluation and then to blood collection for the following laboratorytests: blood count (performed on automatic analyzer), quantification...(AU)

Accurate identification of atypical Staphylococcus chromogenes plasma-clotting strains causing bovine mastitis / Identificação acurada de cepas atípicas de Staphylococcus chromogenes que coagulam o plasma envolvidas com mastite bovina

We compared the potential of routine techniques used for the identification of Staphylococcus species, aiming to evaluate their accuracy in the detection of 43 Staphylococcus chromogenes strains isolated from bovine mastitis that, despite being a coagulase-negative species, are able to clot plasma. These strains could be mistakenly suspected to be S. aureus and lead to an unappropriated treatment of the disease. MALDI-TOF, PCR-RFLP of the chaperonine gene groEL, and sequencing of the 16S rRNA and elongation factor Tu gene tuf were employed. Results from the four methods were coincident for only half of the strains because of the low accuracy of the groEL PCR-RFLP (51.2% accuracy). Even though all the sequencing results were identical, the high accuracy of the MALDI-TOF results (97.7% accuracy, with only one strain misidentified) encourage the use of this technique, since it does not require laborious sample preparation, being fast and simple to perform.(AU)

Nós comparamos o potencial de técnicas rotineiras utilizadas para a identificação de espécies de Staphylococcus, com o objetivo de avaliar a acurácia delas na detecção de 43 isolados de Staphylococcus chromogenes envolvidos com mastite bovina que, apesar de ser uma espécie coagulase-negativa, são capazes de coagular o plasma. Essas cepas poderiam ser erroneamente suspeitas de serem S. aureus e levarem a um tratamento não adequado da doença. MALDI-TOF, PCR-RFLP do gene da chaperonina groEL e sequenciamento do gene do rRNA 16S e do gene do fator de elongação Tu, tuf, foram avaliados. Os resultados dos quatro métodos foram coincidentes para apenas metade das cepas, devido à baixa precisão da PCR-RFLP com groEL (51,2% de acurácia). Apesar de todos os resultados do sequenciamento serem idênticos, a alta precisão dos resultados do MALDI-TOF (97,7% de acurácia, com apenas uma cepa identificada incorretamente) encoraja o uso dessa técnica, pois, não requer preparação laboriosa de amostras, sendo rápida e simples de executar.(AU)

Delayed double reading of whole blood clotting test (WBCT) results at 20 and 30 minutes enhances diagnosis and treatment of viper evenomation

The whole blood clotting test (WBCT) is a simple test of coagulation that is often used in the assessment, diagnosis, and therapeutic monitoring of snakebite patients in sub-Saharan Africa. WBCT requires only a clean glass tube and several milliliters of venous blood and is ideal for use in poorly equipped health centers throughout the rural areas where 95% of snakebites occur. However, questions surrounding the accuracy and reliability of the test remain unanswered due to variations in testing conditions and a lack of comparative research with which to validate them. This is the first study to evaluate WBCT results at both 20-min (WBCT20) and 30-min (WBCT30) reading times in the same group of snakebite patients. Methods In order to define the best reading time, the authors compared the results of serial WBCT evaluation at both 20 and 30 min after collection in 23 patients treated for snake envenomation in Bembèrèkè, northern Benin. Results WBCT results were identical at both reading times in patients without coagulopathy or when coagulation was restored permanently following a single dose of antivenom. Out of 17 patients with coagulopathy, 14 showed discrepancies between WBCT20 and WBCT30 results in at least one pair of serial evaluations. These could be completely contradictory results (e.g. normal clot at WBCT20 and no clot at WBCT30) or a marked difference in the quality of the clot (e.g. no clotting activity at WBCT20 and an unstable partial clot at WBCT30)...(AU)

Delayed double reading of whole blood clotting test (WBCT) results at 20 and 30 minutes enhances diagnosis and treatment of viper evenomation

The whole blood clotting test (WBCT) is a simple test of coagulation that is often used in the assessment, diagnosis, and therapeutic monitoring of snakebite patients in sub-Saharan Africa. WBCT requires only a clean glass tube and several milliliters of venous blood and is ideal for use in poorly equipped health centers throughout the rural areas where 95% of snakebites occur. However, questions surrounding the accuracy and reliability of the test remain unanswered due to variations in testing conditions and a lack of comparative research with which to validate them. This is the first study to evaluate WBCT results at both 20-min (WBCT20) and 30-min (WBCT30) reading times in the same group of snakebite patients. Methods In order to define the best reading time, the authors compared the results of serial WBCT evaluation at both 20 and 30 min after collection in 23 patients treated for snake envenomation in Bembèrèkè, northern Benin. Results WBCT results were identical at both reading times in patients without coagulopathy or when coagulation was restored permanently following a single dose of antivenom. Out of 17 patients with coagulopathy, 14 showed discrepancies between WBCT20 and WBCT30 results in at least one pair of serial evaluations. These could be completely contradictory results (e.g. normal clot at WBCT20 and no clot at WBCT30) or a marked difference in the quality of the clot (e.g. no clotting activity at WBCT20 and an unstable partial clot at WBCT30)...

Kn-Ba: a novel serine protease isolated from Bitis arietans snake venom with fibrinogenolytic and kinin-releasing activities

Bitis arietans is a venomous snake found in sub-Saharan Africa and in parts of Morocco and Saudi Arabia. The envenomation is characterized by local and systemic reactions including pain, blistering, edema and tissue damage, besides hemostatic and cardiovascular disturbances, which can cause death or permanent disabilities in its victims. However, the action mechanisms that provoke these effects remain poorly understood, especially the activities of purified venom components. Therefore, in order to elucidate the molecular mechanisms that make the Bitis arietans venom so potent and harmful to human beings, this study reports the isolation and biochemical characterization of a snake venom serine protease (SVSP). Methods: Solubilized venom was fractionated by molecular exclusion chromatography and the proteolytic activity was determined using fluorescent substrates. The peaks that showed serine protease activity were determined by blocking the proteolytic activity with site-directed inhibitors. In sequence, the fraction of interest was submitted to another cycle of molecular exclusion chromatography. The purified serine protease was identified by mass spectrometry and characterized biochemically and immunochemically. Results: A serine protease of 33 kDa with fibrinogen-degrading and kinin-releasing activities was isolated, described, and designated herein as Kn-Ba. The experimental Butantan Institute antivenom produced against Bitis arietans venom inhibited the Kn-Ba activity. Conclusions: The in vitro activities of Kn-Ba can be correlated with the capacity of the venom to provoke bleeding and clotting disorders as well as hypotension, which are common symptoms presented by envenomed victims. Obtaining satisfactory Kn-Ba inhibition through the experimental antivenom is important, given the WHO's recommendation of immunotherapy in cases of human accidents with venomous snakes.(AU)

Systemic toxic reaction due to multiple honeybee stings in equine: Case report / Reação tóxica sistêmica devido a múltiplas ferroadas de abelha em equino: relato de caso

Accidents caused by insects of the Hymenoptera are rarely described in large animals. The attacks caused by honeybee (Apis mellifera) may cause severe consequences and its intensity changes according to the number of stings. Local and systemic reactions can occur, including progression to death. This report describes a case of honeybee attack on an equine, which took place in the city of Lages, in the state of Santa Catarina, Brazil. In the clinical assessment the horse showed apathy, anorexia, head and pectoral edemas, dyspnea, icteric mucosa, increased mandibular lymph nodes and darkened urine. The blood count showed anemia and serum biochemical tests suggested, muscular and hepatic lesions. The urinalysis test indicated hemoglobinuria and increased clotting time. Treatment included lactate Ringer's solution fluid therapy, furosemide, promethazine, corticosteroids and 20% mannitol solution. Hot and cold compresses were applied alternately on areas with edema. There was a satisfactory response to treatment and the animal was discharged after 30 days in veterinary hospital. The description of honeybee sting accidents in large animals is important because of the evolution that can lead to death. The early approach associated with appropriate treatment, avoiding the worsening of the lesions is fundamental for the recovery of the patient.(AU)

Os acidentes causados por insetos da ordem Hymenoptera são raramente descritos em grandes animais. Os ataques provocados por abelhas (Apis mellifera) causam consequências graves, e sua intensidade varia de acordo com a quantidade de ferroadas. Reações locais a sistêmicas podem ocorrer, incluindo a evolução para a morte. Este relato descreve um caso de ataque por abelhas em equino, ocorrido no município de Lages, SC. No exame clínico, o equino apresentava apatia, anorexia, edema de cabeça e região peitoral, dispneia inspiratória, mucosas ictéricas, linfonodos mandibulares aumentados e urina de coloração marrom-escura. O hemograma evidenciou anemia hemolítica, e os exames de bioquímica sérica sugeriram lesão muscular e lesão hepática. A urinálise demonstrou hemoglobinúria, e o tempo de coagulação apresentava-se aumentado. Como tratamento, foram administrados solução de ringer com lactato, furosemida, prometazina, corticosteroides e solução de manitol a 20%. Compressas quentes e frias foram aplicadas alternadamente sobre as áreas de edema. Houve adequada resposta ao tratamento instituído e o animal recebeu alta hospitalar após 30 dias de internamento. A descrição de casos de acidentes por picadas de abelhas em grandes animais é importante devido à evolução, que pode levar à morte. A abordagem precoce associada ao tratamento adequado, evitando o agravamento das lesões, é fundamental para a recuperação do paciente.(AU)

Systemic toxic reaction due to multiple honeybee stings in equine: Case report / Reação tóxica sistêmica devido a múltiplas ferroadas de abelha em equino: relato de caso

Accidents caused by insects of the Hymenoptera are rarely described in large animals. The attacks caused by honeybee (Apis mellifera) may cause severe consequences and its intensity changes according to the number of stings. Local and systemic reactions can occur, including progression to death. This report describes a case of honeybee attack on an equine, which took place in the city of Lages, in the state of Santa Catarina, Brazil. In the clinical assessment the horse showed apathy, anorexia, head and pectoral edemas, dyspnea, icteric mucosa, increased mandibular lymph nodes and darkened urine. The blood count showed anemia and serum biochemical tests suggested, muscular and hepatic lesions. The urinalysis test indicated hemoglobinuria and increased clotting time. Treatment included lactate Ringer's solution fluid therapy, furosemide, promethazine, corticosteroids and 20% mannitol solution. Hot and cold compresses were applied alternately on areas with edema. There was a satisfactory response to treatment and the animal was discharged after 30 days in veterinary hospital. The description of honeybee sting accidents in large animals is important because of the evolution that can lead to death. The early approach associated with appropriate treatment, avoiding the worsening of the lesions is fundamental for the recovery of the patient.(AU)

Os acidentes causados por insetos da ordem Hymenoptera são raramente descritos em grandes animais. Os ataques provocados por abelhas (Apis mellifera) causam consequências graves, e sua intensidade varia de acordo com a quantidade de ferroadas. Reações locais a sistêmicas podem ocorrer, incluindo a evolução para a morte. Este relato descreve um caso de ataque por abelhas em equino, ocorrido no município de Lages, SC. No exame clínico, o equino apresentava apatia, anorexia, edema de cabeça e região peitoral, dispneia inspiratória, mucosas ictéricas, linfonodos mandibulares aumentados e urina de coloração marrom-escura. O hemograma evidenciou anemia hemolítica, e os exames de bioquímica sérica sugeriram lesão muscular e lesão hepática. A urinálise demonstrou hemoglobinúria, e o tempo de coagulação apresentava-se aumentado. Como tratamento, foram administrados solução de ringer com lactato, furosemida, prometazina, corticosteroides e solução de manitol a 20%. Compressas quentes e frias foram aplicadas alternadamente sobre as áreas de edema. Houve adequada resposta ao tratamento instituído e o animal recebeu alta hospitalar após 30 dias de internamento. A descrição de casos de acidentes por picadas de abelhas em grandes animais é importante devido à evolução, que pode levar à morte. A abordagem precoce associada ao tratamento adequado, evitando o agravamento das lesões, é fundamental para a recuperação do paciente.(AU)

Kn-Ba: a novel serine protease isolated from Bitis arietans snake venom with fibrinogenolytic and kinin-releasing activities

Background: Bitis arietans is a venomous snake found in sub-Saharan Africa and in parts of Morocco and Saudi Arabia. The envenomation is characterized by local and systemic reactions including pain, blistering, edema and tissue damage, besides hemostatic and cardiovascular disturbances, which can cause death or permanent disabilities in its victims. However, the action mechanisms that provoke these effects remain poorly understood, especially the activities of purified venom components. Therefore, in order to elucidate the molecular mechanisms that make the Bitis arietans venom so potent and harmful to human beings, this study reports the isolation and biochemical characterization of a snake venom serine protease (SVSP). Methods: Solubilized venom was fractionated by molecular exclusion chromatography and the proteolytic activity was determined using fluorescent substrates. The peaks that showed serine protease activity were determined by blocking the proteolytic activity with site-directed inhibitors. In sequence, the fraction of interest was submitted to another cycle of molecular exclusion chromatography. The purified serine protease was identified by mass spectrometry and characterized biochemically and immunochemically. Results: A serine protease of 33 kDa with fibrinogen-degrading and kinin-releasing activities was isolated, described, and designated herein as Kn-Ba. The experimental Butantan Institute antivenom produced against Bitis arietans venom inhibited the Kn-Ba activity. Conclusions: The in vitro activities of Kn-Ba can be correlated with the capacity of the venom to provoke bleeding and clotting disorders as well as hypotension, which are common symptoms presented by envenomed victims. Obtaining satisfactory Kn-Ba inhibition through the experimental antivenom is important, given the WHO's recommendation of immunotherapy in cases of human accidents with venomous snakes.(AU)

Thromboelastometry - diagnostic examination method of clot formation in pigs subjected to experimental procedures of the left atrial appendage / Tromboelastometria - método de análise de diagnóstico e formação de coágulos em suínos submetidos a procedimentos experimentais da aurícula atrial esquerda

The aim of the study was to evaluate the usefulness of thromboelastometry in evaluations of the blood clotting system in pigs subjected to clip occlusion of the left atrial appendage. In this study, blood samples for thromboelastometry were collected, after clip occlusion of the left atrial appendage, from five pigs, in order to assess clot quality formation. Thromboelastometry with three ROTEM assays were performed: INTEM, EXTEM and FIBTEM. Results of the test were presented in TEMograms. The shape of the graph demonstrates hypercoagulability. In the thromboelastometry examination clot quality was stable in all animals.

O objetivo do estudo foi avaliar a estabilidade de formação de coágulos no tromboelastometria em suínos submetidos à oclusão grampo da aurícula esquerda. Neste estudo, as amostras de sangue foram recolhidas para tromboelastometria, após a oclusão grampo do apêndice atrial esquerdo, a partir de seis animais, a fim de avaliar a qualidade de formação de coágulo. Tromboelastometria com três ensaios foram realizados: INTEM, Extem e FIBTEM. Os resultados do teste foram apresentados em TEMograms. A forma do gráfico demonstra hipercoagulabilidade. Na qualidade de coágulos, o exame de tromboelastometria ficou estável em todos os animais.

Thromboelastometry - diagnostic examination method of clot formation in pigs subjected to experimental procedures of the left atrial appendage / Tromboelastometria - método de análise de diagnóstico e formação de coágulos em suínos submetidos a procedimentos experimentais da aurícula atrial esquerda

The aim of the study was to evaluate the usefulness of thromboelastometry in evaluations of the blood clotting system in pigs subjected to clip occlusion of the left atrial appendage. In this study, blood samples for thromboelastometry were collected, after clip occlusion of the left atrial appendage, from five pigs, in order to assess clot quality formation. Thromboelastometry with three ROTEM assays were performed: INTEM, EXTEM and FIBTEM. Results of the test were presented in TEMograms. The shape of the graph demonstrates hypercoagulability. In the thromboelastometry examination clot quality was stable in all animals.(AU)

O objetivo do estudo foi avaliar a estabilidade de formação de coágulos no tromboelastometria em suínos submetidos à oclusão grampo da aurícula esquerda. Neste estudo, as amostras de sangue foram recolhidas para tromboelastometria, após a oclusão grampo do apêndice atrial esquerdo, a partir de seis animais, a fim de avaliar a qualidade de formação de coágulo. Tromboelastometria com três ensaios foram realizados: INTEM, Extem e FIBTEM. Os resultados do teste foram apresentados em TEMograms. A forma do gráfico demonstra hipercoagulabilidade. Na qualidade de coágulos, o exame de tromboelastometria ficou estável em todos os animais.(AU)

Associação de plasma sanguíneo ao tratamento de envenenamento botrópico em equino: relato de caso / Plasma blood associated with the treatment of bothropic poisoning in equine: case report

O presente trabalho tem por objetivo relatar um caso de envenenamento botrópico em um equino, fêmea, seis anos de idade, da raça Quarto de Milha, pesando 460kg, que foi atendido no hospital veterinário da FCAV/Unesp, Campus de Jaboticabal, SP. No exame clínico, observou-se aumento bilateral de narina, com extrema sensibilidade ao toque, presença das marcas da presa da serpente na região rostral de focinho, mucosas róseas com petéquias. No exame de sangue, pôde-se detectar alteração no tempo de coagulação sanguínea (>30 minutos). O animal permaneceu internado, sendo instituída a seguinte terapia: soro antiofídico polivalente, transfusão de plasma sanguíneo equino, fluidoterapia intensa, flunixin meglumine e sulfa associado ao trimetoprim. A associação da transfusão de plasma sanguíneo equino ao tratamento convencional foi de extrema importância para correção da coagulopatia causada pelo acidente ofídico. A égua apresentou melhora clínica e resolução do quadro de envenenamento após cinco dias da internação.(AU)

This study aims to report a case of blood plasma association with the treatment of bothrops poisoning in an equine, female, six years of age, Quarter Horses, weighing 460 kg, which was served in the veterinary hospital of the FCAV/UNESP, Jaboticabal/SP. Clinical examination showed bilateral increase in nostrils, with great sensitivity to touch, presence of snake prey marks the rostral region of the snout, mucous rosy and with petechiae. Blood samples showed changes in blood clotting time (> 30 minutes). The animal remained in hospitalization with the following treatment: polyvalent antivenom, blood plasma transfusion, intensive fluid therapy, flunexim meglumine and sulfa associated with trimethoprim. The association of transfusion equine blood plasma to conventional treatment was extremely important for correction of coagulopathy caused by snakebite. The mare showed clinical improvement and resolution of poisoning symptoms after five days of hospitalization.(AU)