Taiwan cobra envenoming: serum venom concentration before and after specific treatment and relationship with debridement of necrotic wound tissue

Background: Bivalent freeze-dried neurotoxic (FN) antivenom has been the primary treatment since the 1980s for Taiwan cobra (Naja atra) envenomation in Taiwan. However, envenomation-related wound necrosis is a significant problem after cobra snakebites. In the present study, we analyzed the changes in serum venom concentration before and after antivenom administration to discover their clinical implications and the surgical treatment options for wound necrosis. Methods: The patients were divided into limb swelling and wound necrosis groups. The clinical outcome was that swelling started to subside 12 hours after antivenom treatment in the first group. Serum venom concentrations before and after using antivenoms were measured to assess the antivenom's ability to neutralize the circulating cobra venom. The venom levels in wound wet dressing gauzes, blister fluids, and debrided tissues were also investigated to determine their clinical significance. We also observed the evolutional changes of wound necrosis and chose a better wound debridement timing. Results: We prospectively enrolled 15 Taiwan cobra snakebite patients. Males accounted for most of this study population (n = 11, 73%). The wound necrosis group received more antivenom doses than the limb swelling group (4; IQR:2-6 vs 1; IQR:1-2, p = 0.05), and less records of serum venom concentrations changed before/after antivenom use (p = 0.0079). The necrotic wound site may release venom into circulation and cause more severe envenomation symptoms. Antivenom can efficiently diminish limb swelling in cobra bite patients. However, antivenom cannot reduce wound necrosis. Patients with early debridement of wound necrosis had a better limb outcome, while late or without debridement may have long-term hospital stay and distal limb morbidity. Conclusions: Antivenom can efficiently eliminate the circulating cobra venom in limb swelling patients without wound necrosis. Early debridement of the bite site wound and wet dressing management are suggestions for preventing extended tissue necrosis and hospital stay.(AU)

Comparison of carbon sequestration potential in agricultural and afforestation farming systems

In the last few decades, many forests have been cut down to make room for cultivation and to increase food or energy crops production in developing countries. In this study, carbon sequestration and wood production were evaluated on afforested farms by integrating the Gaussian diameter distribution model and exponential diameter-height model derived from sample plots of an afforested hardwood forest in Taiwan. The quantity of sequestrated carbon was determined based on aboveground biomass. Through pilot tests run on an age-volume model, an estimation bias was obtained and used to correct predicted volume estimates for a farm forest over a 20-year period. An estimated carbon sequestration of 11,254 t C was observed for a 189ha-hardwood forest which is equivalent to 41,264 t CO2. If this amount of carbon dioxide were exchanged on the Chicago Climate Exchange (CCX) market, the income earned would be 821 US$ ha - 1. Carbon sequestration from rice (Oryza sativa) or sugarcane (Saccharum officinarum) production is discharged as a result of straw decomposition in the soil which also improves soil quality. Sugarcane production does not contribute significantly to carbon sequestration, because almost all the cane fiber is used as fuel for sugar mills. As a result of changing the farming systems to hardwood forest in this study area, carbon sequestration and carbon storage have increased at the rate of 2.98 t C ha - 1 year - 1. Net present value of afforestation for a 20-year period of carbon or wood management is estimated at around US$ 30,000 given an annual base interest rate of 3 %.

Comparison of carbon sequestration potential in agricultural and afforestation farming systems

In the last few decades, many forests have been cut down to make room for cultivation and to increase food or energy crops production in developing countries. In this study, carbon sequestration and wood production were evaluated on afforested farms by integrating the Gaussian diameter distribution model and exponential diameter-height model derived from sample plots of an afforested hardwood forest in Taiwan. The quantity of sequestrated carbon was determined based on aboveground biomass. Through pilot tests run on an age-volume model, an estimation bias was obtained and used to correct predicted volume estimates for a farm forest over a 20-year period. An estimated carbon sequestration of 11,254 t C was observed for a 189ha-hardwood forest which is equivalent to 41,264 t CO2. If this amount of carbon dioxide were exchanged on the Chicago Climate Exchange (CCX) market, the income earned would be 821 US$ ha - 1. Carbon sequestration from rice (Oryza sativa) or sugarcane (Saccharum officinarum) production is discharged as a result of straw decomposition in the soil which also improves soil quality. Sugarcane production does not contribute significantly to carbon sequestration, because almost all the cane fiber is used as fuel for sugar mills. As a result of changing the farming systems to hardwood forest in this study area, carbon sequestration and carbon storage have increased at the rate of 2.98 t C ha - 1 year - 1. Net present value of afforestation for a 20-year period of carbon or wood management is estimated at around US$ 30,000 given an annual base interest rate of 3 %.(AU)

Wound infections secondary to snakebite in central Taiwan

There are very few microbiological data on wound infections following snakebites. The objective of this study was to investigate the treatment of secondary infection following snakebites in central Taiwan. Microbiological data and antibiotic sensitivity of wound cultures were retrospectively analyzed from December 2005 to October 2007 in a medical center in central Taiwan. A total of 121 snakebite patients participated in the study. Forty-nine (40.5%) subjects were bitten by cobra (Naja atra); 34 of them had secondary infection, and 24 of them (70.6%) needed surgical intervention. Cobra bites caused more severe bacterial infection than other snakebites. Morganella morganii was the most common pathogen, followed by Aeromonas hydrophila and Enterococcus. Gram-negative bacteria were susceptible to amikacin, trimethoprim/sulfamethoxazole, cefotaxime, cefepime, ciprofloxacin, and piperacillin/tazobactam. Enterococcus were susceptible to ampicillin, gentamicin, penicillin and vancomycin. It is reasonable to choose piperacillin/tazobactam, quinolone, second- or third-generation cephalosporin for empirical therapy following snakebite. Surgical intervention should be considered for invasive soft tissue infections.(AU)

Wound infections secondary to snakebite in central Taiwan

There are very few microbiological data on wound infections following snakebites. The objective of this study was to investigate the treatment of secondary infection following snakebites in central Taiwan. Microbiological data and antibiotic sensitivity of wound cultures were retrospectively analyzed from December 2005 to October 2007 in a medical center in central Taiwan. A total of 121 snakebite patients participated in the study. Forty-nine (40.5%) subjects were bitten by cobra (Naja atra); 34 of them had secondary infection, and 24 of them (70.6%) needed surgical intervention. Cobra bites caused more severe bacterial infection than other snakebites. Morganella morganii was the most common pathogen, followed by Aeromonas hydrophila and Enterococcus. Gram-negative bacteria were susceptible to amikacin, trimethoprim/sulfamethoxazole, cefotaxime, cefepime, ciprofloxacin, and piperacillin/tazobactam. Enterococcus were susceptible to ampicillin, gentamicin, penicillin and vancomycin. It is reasonable to choose piperacillin/tazobactam, quinolone, second- or third-generation cephalosporin for empirical therapy following snakebite. Surgical intervention should be considered for invasive soft tissue infections.(AU)

Isolation and characteristics of lactic acid bacteria isolated from ripe mulberries in Taiwan

The objective of this study was to isolate, characterize, and identify lactic acid bacteria (LAB) from ripe mulberries collected in Taiwan. Ripe mulberry samples were collected at five mulberry farms, located in different counties of Taiwan. Eighty-eight acid-producing cultures were isolated from these samples, and isolates were divided into classes first by phenotype, then into groups by restriction fragment length polymorphism (RFLP) analysis and sequencing of 16S ribosomal DNA (rDNA). Phenotypic and biochemical characteristics led to identification of four bacterial groups (A to D). Weissella cibaria was the most abundant type of LAB distributed in four mulberry farms, and Lactobacillus plantarum was the most abundant LAB found in the remaining farm. Ten W. cibaria and one Lactococcus lactis subsp. lactis isolate produced bacteriocins against the indicator strain Lactobacillus sakei JCM 1157T. These results suggest that various LAB are distributed in ripe mulberries and W. cibaria was the most abundant LAB found in this study.