Holy Medicine: Patron Saints of Wounds Due to Animal Bites.

The cult of saints in Western Europe developed during the late period of antiquity and the early Middle Ages. Their importance to European society was undeniable; holy medicine was the only hope for people, because there were no doctors. The number of saints had increased over the years, and people sought medical help from them through prayer and other religious practices. Some of the saints became "specialized" in treating various wounds and dermatologic diseases. During our research, we tried to determine whether the cult of saints led to the develop-ment of hospitals that treated skin diseases, as discovered in the Hospital Brother of Saint Anthony. A large number of saints who were patrons of wounds and skin diseases were collected in three studies. In the first report, we presented a great number of saints who were patrons to treat animal bites. The second report presented patron saints of wounds, ulcers, burns, and frostbites; and the third report decsribed saints who treated contagious diseases (such as ergotism, leprosy, and scabies). The phenomenon of holy medicine is part of the history of dermatology and is important due to "specializations," which refer to an understanding of skin diseases and the methods of treating various wounds and dermatologic diseases.

Who bit the boat? New DNA collection and genomic methods enable species identification in suspected shark-related incidents.

Species identification following shark-related incidents is critical for effective incident management and for collecting data to inform shark-bite mitigation strategies. Witness statements are not always reliable, and species identification is often ambiguous or missing. Alternative methods for species identification include morphological assessments of bite marks, analysis of collected teeth at the scene of the incident, and genetic approaches. However, access to appropriate collection media and robust genetic assays have limited the use of genetic technologies. Here, we present a case study that facilitated a unique opportunity to compare the effectiveness of medical gauze readily available in first-aid kits, and forensic-grade swabs in collecting genetic material for shark-species identification. Sterile medical gauze and forensic-grade swabs were used to collect transfer DNA from the bite margins on a bitten surf ski which were compared to a piece of shark tissue embedded along the bite margin. Witness accounts and the characteristics of the bite mark impressions inferred the involvement of a Carcharodon carcharias (white shark). The morphology of a tooth found on the boat that picked up the surf ski, however, suggested it belonged to an Orectolobus spp. (wobbegong). Genetic analysis of DNA transferred from the shark to the surf ski included the application of a broad-target nested PCR assay followed by Sanger sequencing, with white shark contribution to the 'total sample DNA' determined with a species-specific qPCR assay. The results of the genetic analyses were congruent between sampling methods with respect to species identification and the level of activity inferred by the donor-specific DNA contribution. These data also supported the inferences drawn from the bite mark morphology. DNA from the recovered tooth was PCR amplified with a wobbegong-specific primer pair designed for this study to corroborate the tooth's morphological identification. Following the confirmation of gauze used for sampling in the case study event, two additional isolated incidents occurred and were sampled in situ using gauze, as typically found in a first-aid kit, by external personnel. DNA extracted from these gauze samples resulted in the identification of a white shark as the donor of the DNA collected from the bite marks in both instances. This study, involving three incidents separated by time and location, represents the seminal application of gauze as a sampling media after critical human-shark interactions and strongly supports the practical implementation of these methods in the field.

A prospective study on health seeking behaviour and post exposure prophylaxis received by animal bite victims at the anti-rabies clinic in a tertiary care centre of urban Bangalore.

Background: Rabies is 100% preventable by administering early and complete post exposure prophylaxis (PEP). Animal bite victims must have the knowledge and attitude necessary to seek appropriate medical care at the earliest to receive the required PEP. Objectives: The present study sought to ascertain the health-seeking behavior of animal bite victims, their knowledge and attitude regarding rabies prophylaxis, the PEP they received, and their level of compliance with the full course of anti-rabies vaccination. Methods: The study included animal bite cases that presented to the anti-rabies clinic and matched the eligibility criteria. All the required details were recorded using an internally validated structured questionnaire. All participants were followed up for six months to ensure their health conditions and compliance with the vaccination schedule. Results: Out of 1058 respondents, 57.9% were adults, with 46.6% belonging to middle socioeconomic class. 91.1% of them were informed biting animals as dogs. Before arriving at the anti-rabies clinic, 93.3% of the study subjects washed their wounds, and 62.4% visited to another health facility. Rabies knowledge was inadequate among the study participants, only 54.8% being mindful about the disease and its prevention. The compliance with the full course of antirabies vaccination was found to be 77.9%. All subjects were healthy, confirming that PEP is safe and effective. Conclusion: Regular social and behavioral change communication (SBCC) needs to be implemented with regard to health-seeking behavior.

Profile and Geospatial Analysis of Dog Bite Cases Attending the Antirabies Vaccine Outpatient Department at the Tertiary Level Hospital of Mumbai.

BACKGROUND: Dog bites pose a significant public health concern in India, necessitating an understanding of their epidemiological profile and spatial distribution. Adopting the One Health approach, which considers the interconnection of human, animal, and environmental health, is vital for developing effective interventions. OBJECTIVES: The study aimed to assess the epidemiological profile and geospatial trends of dog bite cases in an urban area, focusing on the age and gender distribution of victims, severity of bites, and spatial distribution of cases to inform prevention strategies. MATERIALS AND METHODS: A retrospective secondary data analysis was conducted on dog bite cases reported in 2022 at a tertiary care hospital in Mumbai. The epidemiological profile, including age, gender, and severity of bites, was examined. Quantum Geographic Information System (QGIS) was utilized for spatial distribution analysis, identifying hotspots within the urban area. RESULTS: Of the 3350 cases, 70.7% were below 40 years old, 81.6% were male, and 78.18% had Category III bites indicating severe injuries. Most cases (74%) were caused by stray dogs. QGIS analysis revealed five hotspots within the urban area. CONCLUSION: The study highlights the predominance of dog bites among younger males and the severity of injuries. Spatial analysis identified specific hotspots, underscoring the need for targeted interventions. Implementing a comprehensive surveillance system incorporating GIS technology and adopting a One Health approach can enhance the control and prevention of dog bite cases and reduce the risk of rabies outbreaks.

Post-mortem diagnosis of human rabies in SARS-CoV-2 coinfected patient with minimally invasive autopsy in northeastern Brazil.

INTRODUCTION: Human rabies (HR) is a lethal zoonotic disease caused by lyssaviruses with increase in the number of cases post-coronavirus disease 2019 (COVID-19) pandemic. METHODOLOGY: We report a case of human rabies in a patient from a rural area of Ceará, northeastern Brazil in 2023, who was bitten by a white-tufted-ear marmoset (Callithrix jacchus jacchus). The patient was co-infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and was diagnosed by minimally invasive autopsy (MIA). RESULTS: MIA offers many advantages related to biosafety, and speed of sample acquisition; and markedly reduces disfigurement of the body compared with complete autopsy. It is a great alternative in COVID-19 patients. CONCLUSIONS: New methods such as MIA are a promising tool for diagnosis, and have the potential to improve family cooperation and support rabies surveillance.

Probable paralytic rabies in a dog: ante-mortem clinical diagnosis implications in limited resource settings.

INTRODUCTION: Rabies is a dreadful zoonotic viral disease that affects animals and humans with a fatality rate of 100%. This report aims to create awareness among the veterinarians and general public about the paralytic form of rabies in order to understand the antemortem clinical diagnosis implications in limited resource settings, so as to follow the post-exposure prophylaxis at the golden hour period of rabies transmission. CASE PRESENTATION: A one-year-old female dog was presented to the Ambulatory Clinic Unit, Veterinary Clinical Complex, Veterinary College and Research Institute, Theni, Tamil Nadu, India with the ailment of a dropped jaw and was unable to swallow food and water for the past three days. Epidemiological investigations revealed that the animal had dog-bitten wounds from a week ago. On clinical examination, facial distortion, changes in the vocal cord, and paralysis of the throat muscle were noticed. Based on the anamnesis, clinical, and epidemiological investigations, the animal was diagnosed to be a probable case of paralytic form of canine rabies. In the limited resource settings, antemortem clinical diagnosis was practiced to suspect rabies-infected dogs. Further, the owner was advised to implement preventive measures to safeguard against rabies infection. The dog was kept under isolation and succumbed on day two with evidence of progressive paralytic signs. CONCLUSIONS: This report emphasizes the importance of paralytic rabies, alongside of furious form of rabies, further creating awareness among the general public about the antemortem clinical diagnosis under limited resource settings.

Jellyfish Stings: A Review of Skin Symptoms, Pathophysiology, and Management.

With the surge in the human coastal population and the increasing frequency of human activities along the coast, cases of marine envenomation, particularly jellyfish envenomation, have notably risen. Jellyfish stings can induce a spectrum of symptoms that vary in severity, encompassing skin injuries, acute systemic venom effects, delayed indirect sequelae, and even fatality, causing significant distress to patients. Among these manifestations, the occurrence of skin lesions following jellyfish stings is prevalent and substantial. These lesions are characterized by evident blister formation, development of bullae, subcutaneous hemorrhage, erythema, papules, wheal, ecchymosis, and ulceration or skin necrosis. Local cutaneous manifestations may persist for several weeks or even months after the initial sting. Despite aggressive treatment, many skin injuries still result in significant pigmentation or scarring after recovery. To address this issue effectively, it is imperative to conduct comprehensive evidence-based medical research, elucidate various components within jellyfish venom, and elucidate its pathogenic mechanism to develop targeted treatment programs. This article aims to review the skin symptoms, pathophysiology, and management of jellyfish stings. Such considerations can provide comprehensive guidance to medical professionals and the public and minimize the harm caused by jellyfish stings.

Personal electric deterrents can reduce shark bites from the three species responsible for the most fatal interactions.

The frequency of unprovoked shark bites is increasing worldwide, leading to a growing pressure for mitigation measures to reduce shark-bite risk while maintaining conservation objectives. Personal shark deterrents are a promising and non-lethal strategy that can protect ocean users, but few have been independently and scientifically tested. In Australia, bull (Carcharhinus leucas), tiger (Galeocerdo cuvier), and white sharks (Carcharodon carcharias) are responsible for the highest number of bites and fatalities. We tested the effects of two electric deterrents (Ocean Guardian's Freedom+ Surf and Freedom7) on the behaviour of these three species. The surf product reduced the probability of bites by 54% across all three species. The diving product had a similar effect on tiger shark bites (69% reduction) but did not reduce the frequency of bites from white sharks (1% increase), likely because the electrodes were placed further away from the bait. Electric deterrents also increased the time for bites to occur, and frequency of reactions and passes for all species tested. Our findings reveal that both Freedom+ Surf and Freedom7 electric deterrents affect shark behaviour and can reduce shark-bite risk for water users, but neither product eliminated the risk of shark bites entirely. The increasing number of studies showing the ability of personal electric deterrents to reduce shark-bite risk highlights personal protection as an effective and important part of the toolbox of shark-bite mitigation measures.

Rabies knowledge gaps and risk behaviour in Dutch travellers: An observational cohort study.

BACKGROUND: Travellers visiting rabies-endemic countries are at risk of rabies infection. Assessing travellers' knowledge and risk perception of rabies and risk behaviour during travel can help identify knowledge gaps and improve pre-travel risk education. METHODS: Cohort study in Dutch adult travellers, using two surveys: one before travel to assess knowledge and perception of rabies, and one after return to identify risk behaviour during travel. RESULTS: The pre-travel and post-travel survey were completed by 301 and 276 participants, respectively. 222 participants had travelled to a high-risk rabies-endemic country. 21.6 % of the participants scored their rabies knowledge as poor. Some participants were unaware cats or bats can transmit rabies (26.6 % and 13.6 %, respectively), or that post-exposure prophylaxis (PEP) is required for certain exposures such as skin abrasions without bleeding or licks on damaged skin (35.5 % and 18.9 %, respectively), while 27.9 % of participants did not know PEP needs to be administered within one day. 115 participants (51.8 %) reported any form of contact with any animal during travel. Two participants reported animal exposure, of which one took adequate PEP measures. Risk factors for animal contact abroad were regularly touching cats or dogs at home or abroad, longer travel duration, having pets during childhood and being an animal lover. CONCLUSIONS: Pre-travel rabies risk education currently does not meet travellers' needs, which is reflected in knowledge gaps and engagement in risk behaviour during travel. During pre-travel health advice, avoiding animal contact abroad should be emphasized, and additional education is required about indications for PEP.

Repair of facial dog bite wound utilizing cryopreserved umbilical cord allograft.

BACKGROUND: In the United States, craniofacial injuries are the most frequently observed traumas in the pediatric population. Human birth tissue products contain growth factors, cytokines, and signaling molecules that can be potentially harnessed for tissue regeneration and wound healing. PURPOSE: A cryopreserved ultra-thick amniotic membrane (AM) allograft wound dressing was used in a patient with significant facial soft tissue loss due to a dog bite injury. METHODS: This is a single case report of a pediatric patient. After obtaining IRB exemption, operative and postoperative clinic notes were reviewed. RESULTS: A 10-year-old female presented to the emergency department after suffering a dog bite to her left cheek and upper lip, resulting in tissue loss. A cryopreserved ultra-thick AM allograft was used to cover the area of tissue loss as part of surgical reconstruction. The patient was followed up at 1 week, 3 weeks, 4 months, and 1 year after the graft was placed, and rapid healing and full epithelialization were achieved in addition to scar contracture due to wound location. CONCLUSION: In the setting of acute trauma and tissue loss, human birth tissue was found to promote epithelialization and regenerative healing of facial tissues.

Animal Bites and Attacks.

This text serves to familiarize readers with animal bites and attacks. Topics include appropriate management of animal bite wounds, postexposure prophylaxis for possible rabies exposures, and unique infectious diseases transmitted through animal vectors. Large mammal attacks are discussed, in addition to the management of smaller animal attacks and exposures.

Clinical Management of North American Snake and Marine Envenomations.

Envenomations are the 23rd most common reason for calls to US poison control centers, with over 35,000 incidents reported annually. Snake bites account for over 20% of those calls, while marine envenomations are likely underreported at 3% to 4%.1 While these types of envenomations may not be encountered on a daily basis for many physicians, the different types of envenomations warrant unique management strategies based on the offending creature and symptom presentation. This text serves as a review of the epidemiology, clinical presentations, and management of endemic North American species of snakes and marine vertebrate and invertebrate envenomations.

Dog bites are increasing in frequency and severity - a sustained effect following the COVID-19 pandemic.

The COVID-19 pandemic and subsequent lockdown measures have changed various aspects of society, including patterns of human-animal interactions. This audit investigates the incidence and severity of dog bites admitted under the plastic surgery department at a major trauma centre before and after COVID-19 lockdowns. We assessed trends in dog bite cases over the course of one year (2018) prior to the COVID-19 lockdown and one year after (2022). A time period during COVID-19 lockdown itself was not included to avoid confounding factors due to changes in healthcare provision during the pandemic. Our analysis reveals a 47 % increase in dog bites after lockdowns ended compared to before. We also demonstrate statistically significant increases in the need for operative management (90 % of patients compared to 78 %) and length of inpatient hospital stay (average 63 h compared to 51). Moreover we show that dog bites have increased in severity, with a clear increase in patients presenting with deeper tissue injuries, tissue loss and muscle, nerve, vascular or bone involvement. This represents a significant functional, cosmetic and psychological impact for patients as well as financial impact on the NHS and increased workload for plastic surgery departments. This is the first paper to examine the severity of dog bite injuries and to demonstrate a sustained effect even after the easing of lockdown measures. Our findings shed light on the potential impact of lockdown measures on human-dog interactions and highlight the importance of public awareness and prevention strategies in mitigating dog bites. LAY SUMMARY: Our study demonstrates that dog bite injuries increased in frequency by 47 % following COVID-19 lockdowns. Patients with dog bites are also being admitted for longer than before, requiring more operations and have more severe injuries, with some requiring skin grafting, nerve repair or more complex plastic surgery reconstruction.

Review of psychological effects of dog bites in children.

BACKGROUND: Dog bites are a concerning health problem in children and one of the leading causes of non-fatal injuries in this population. Dog attacks not only cause physical injuries but can also lead to long-term psychological problems. A review was performed to investigate the scope of literature on the psychological effects of dog bites on a paediatric population. METHODS: A literature search was performed on Web of Knowledge database between 1982 to June 2023, returning 249 results. 14 primary studies reporting the psychological consequences of dog bites in children or adolescents were classed as eligible and 9 further studies were added from prior knowledge and bibliographical searches. 23 studies involving 1894 participants met the criteria and were included in this review. RESULTS: Of these 23 studies, 8 were case studies or small case series reports (up to n=4), 14 larger descriptive studies and 1 analytical cross-sectional study. There was a mixture of retrospective and prospective data-gathering. The most common psychological consequences of dog bites in children were post-traumatic stress disorder, dog phobia, nightmares and symptoms of anxiety and avoidance behaviours. CONCLUSIONS: Studies on dog bites in a paediatric population with a specific focus on the psychological consequences associated with dog bites and their management are sparse. Future research and practice should more greatly consider the psychological impact on child victims of dog bites and their family members, as well as their management to avoid the development of mental health issues and improve their quality of life. Future research also needs to ascertain the efficacy of using virtual reality in treating children with dog phobia.

Bat Bites and Rabies PEP in the Croatian Reference Centre for Rabies 1995-2020.

Seroprevalence of lyssaviruses in certain bat species has been proven in the Republic of Croatia, but there have been no confirmed positive bat brain isolates or human fatalities associated with bat injuries/bites. The study included a retrospective analysis of bat injuries/bites, post-exposure prophylaxis (PEP) and geographic distribution of bat injuries in persons examined at the Zagreb Antirabies Clinic, the Croatian Reference Centre for Rabies. In the period 1995-2020, we examined a total of 21,910 patients due to animal injuries, of which 71 cases were bat-related (0.32%). Of the above number of patients, 4574 received rabies PEP (20.87%). However, for bat injuries, the proportion of patients receiving PEP was significantly higher: 66 out of 71 patients (92.95%). Of these, 33 received only the rabies vaccine, while the other 33 patients received the vaccine with human rabies immunoglobulin (HRIG). In five cases, PEP was not administered, as there was no indication for treatment. Thirty-five of the injured patients were biologists or biology students (49.29%). The bat species was confirmed in only one of the exposure cases. This was a serotine bat (Eptesicus serotinus), a known carrier of Lyssavirus hamburg. The results showed that the bat bites were rather sporadic compared to other human injuries caused by animal bites. All bat injuries should be treated as if they were caused by a rabid animal, and according to WHO recommendations. People who come into contact with bats should be strongly advised to be vaccinated against rabies. Entering bat habitats should be done with caution and in accordance with current recommendations, and nationwide surveillance should be carried out by competent institutions and in close collaboration between bat experts, epidemiologists and rabies experts.

Hot-Water Immersion (HWI) or Ice-Pack Treatment (IPT) as First Aid for Human Envenomation by Marine Animals? Review of Literature.

Envenomation by marine animals poses a significant health concern globally, affecting both local residents and tourists in coastal regions. The primary objective of this review is to critically evaluate the existing scientific literature to determine the most effective first-aid treatment for envenomations caused by marine animals, specifically whether hot-water immersion (HWI) or ice-pack treatment (IPT) provides the best immediate care. This comprehensive review covers a wide range of marine envenomations, from jellyfish stings to stingray injuries. While our focus is primarily on the efficacy of HWI and IPT, we also explore the role of cold-water treatment as a result of its relevance and similarity to ice-pack applications. In addition, we examine other treatments mentioned in the literature, such as medications or vinegar, and highlight their findings where applicable. To provide a clear and structured overview, we summarised the articles in separate tables. These tables categorise the type of research conducted, the marine species studied, the region of origin of the marine species, and the key findings of each study. Our analysis of the available evidence indicates a general consensus in the scientific community on the effectiveness of HWI or IPT for envenomation by marine animals. However, when treating those injuries, it is crucial to consider all factors since there is no universally superior treatment due to the diverse nature of marine habitats.