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1.
Anaesth Intensive Care ; 48(5): 399-403, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33017183

RESUMO

An adolescent victim of an urban snakebite developed respiratory failure, rhabdomyolysis and consumption procoagulopathy but recovered with two vials of tiger snake antivenom administered after a delay of 48 hours. The clinical significance of a post-bite collapse was not initially appreciated. Tiger snake (Notechis spp.) venom antigen was measurable in blood before antivenom but not after whereas antivenom was measurable in blood for nine ensuing days. This case adds to growing evidence that further pharmacokinetic research of venom-antivenom interaction is required to establish the correct dose and timing of tiger snake antivenom. Antivenom therapy, even when delayed, facilitates recovery from snake envenomation.


Assuntos
Antivenenos , Mordeduras de Serpentes , Adolescente , Animais , Antivenenos/uso terapêutico , Venenos Elapídicos , Elapidae , Humanos , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/tratamento farmacológico
2.
Toxicon ; 188: 76-79, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33068558

RESUMO

The Brown Widow spider (Latrodectus geometricus) is an invasive species whose geographic range has been expanding worldwide. It is a relative species of the Black Widow and Red-backed spiders of the genus Latrodectus. Despite its broad geographic distribution cases of Brown Widow envenomation have rarely been documented. The venom of L. geometricus is similar to the venom of L. mactans with the primary venom component being alpha-latrotoxin, and consequent envenoming by L. geometricus to humans has resulted in symptoms similar to those reported for other Latrodectus spp. Specific FDA approved Latrodectus antivenom (IgG) available in North America has been effectively used in treating venom-induced symptoms following L. mactans envenoming. The patient reported here involved a confirmed L. geometricus envenoming who was efficaciously treated with an alternately available F(ab')2 antivenom from Mexico.


Assuntos
Antivenenos/uso terapêutico , Viúva Negra , Receptores Imunológicos , Picaduras de Aranhas/tratamento farmacológico , Animais , Humanos
3.
Toxicon ; 186: 94-104, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-32781076

RESUMO

Clinical manifestations of envenomings by bites of the viperid snakes Bothrops asper and Daboia russelii show marked differences. Both venoms elicit the typical effects induced by viperid venoms (local tissue damage, bleeding, coagulopathies, shock). In addition, envenomings by D. russelii are characterized by a high incidence of acute kidney injury and by systemic capillary leak syndrome. The present investigation aimed to compare the local pathological and inflammatory events induced by the intramuscular injection of these venoms in a mouse model. B. asper venom induced stronger local hemorrhage, whereas D. russelii venom caused a higher extent of myonecrosis, and both venoms induced inflammation. Exudates collected from the site of tissue damage showed higher proteolytic activity in the case of samples from B. asper venom-treated mice. This activity was abrogated by antivenoms, indicating that it is the result of the action of venom proteinases. In addition, an increase in matrix metalloproteinases (MMPs) over time was detected in exudates induced by both venoms. Proteome analysis of exudates revealed higher abundance of extracellular matrix (ECM)-derived protein fragments in samples collected from B. asper venom-injected mice, whereas those from D. russelii venom-injected animals had higher amounts of intracellular proteins. Analysis of the subproteome of inflammatory mediators in exudates showed various patterns of change over time. Some mediators peaked at 180 min and decreased afterwards, whereas others increased and remained elevated during the 360 min observation period. Interestingly, various mediators (MIP-1α, MIP-1ß, KC, MIP-2, GM-CSF, VEGF, and LIX) increased and then decreased in the case of B. asper venom, while they remained elevated at 360 min in the case of D. russelii venom. Our findings show that these venoms induce a different pattern of local tissue damage and suggest that the venom of D. russelii induces a more sustained inflammatory reaction, an observation that may have implications for the pathophysiology of envenomings.


Assuntos
Antivenenos/uso terapêutico , Bothrops , Venenos de Crotalídeos , Inflamação/tratamento farmacológico , Víbora de Russell , Mordeduras de Serpentes , Animais , Exsudatos e Transudatos , Hemorragia , Camundongos , Proteoma
4.
PLoS Negl Trop Dis ; 14(8): e0008579, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32817682

RESUMO

BACKGROUND: The World Health Organization's strategy to halve snakebite mortality and morbidity by 2030 includes an emphasis on a risk-benefit process assessing the preclinical efficacy of antivenoms manufactured for sub-Saharan Africa. To assist this process, we systematically collected, standardised and analysed all publicly available data on the preclinical efficacy of antivenoms designed for sub-Saharan Africa. METHODOLOGY/PRINCIPAL FINDINGS: Using a systematic search of publication databases, we focused on publicly available preclinical reports of the efficacy of 16 antivenom products available in sub Saharan Africa. Publications since 1999 reporting the industry standard intravenous pre-incubation method of murine in vivo neutralisation of venom lethality (median effective dose [ED50]) were included. Eighteen publications met the criteria. To permit comparison of the several different reported ED50 values, it was necessary to standardise these to microlitre of antivenom resulting in 50% survival of mice challenged per milligram of venom (µl/mg). We were unable to identify publicly available preclinical data on four antivenoms, whilst data for six polyspecific antivenoms were restricted to a small number of venoms. Only four antivenoms were tested against a wide range of venoms. Examination of these studies for the reporting of key metrics required for interpreting antivenom ED50s were highly variable, as evidenced by eight different units being used for the described ED50 values. CONCLUSIONS/SIGNIFICANCE: There is a disturbing lack of (i) preclinical efficacy testing of antivenom for sub Saharan Africa, (ii) publicly available reports and (iii) independent scrutiny of this medically important data. Where reports do exist, the methods and metrics used are highly variable. This prevents comprehensive meta-analysis of antivenom preclinical efficacy, and severely reduces the utility of antivenom ED50 results in the decision making of physicians treating patients and of national and international health agencies. Here, we propose the use of a standardised result reporting checklist to resolve this issue. Implementation of these straightforward steps will deliver uniform evaluation of products across laboratories, facilitate meta-analyses, and contribute vital information for designing the clinical trials needed to achieve the WHO target of halving snakebite morbidity and mortality by 2030.


Assuntos
Antivenenos/uso terapêutico , Mordeduras de Serpentes/terapia , Venenos de Víboras/antagonistas & inibidores , África ao Sul do Saara , Animais , Anticorpos Neutralizantes/imunologia , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Feminino , Masculino , Camundongos , Venenos de Serpentes , Análise de Sobrevida , Venenos de Víboras/imunologia , Organização Mundial da Saúde
5.
PLoS Negl Trop Dis ; 14(6): e0008379, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32479494

RESUMO

Few studies have addressed gene expression of hemostasis-related factors during acute thrombo-hemorrhagic diseases. Bites by the lanced-headed viper Bothrops jaracaca induce rapid hemostatic disturbances in victims, leading to systemic bleedings, thrombocytopenia and consumption coagulopathy. Although circulating levels of coagulation factors recover rapidly after administration of specific antivenom therapy, it is unclear if B. jararaca venom (BjV) upregulates the mRNA synthesis of hepatic hemostasis-related factors, or if the recovery occurs under basal conditions after the neutralization of venom components by antivenom. Thus, we aimed to investigate if BjV regulates gene expression of important hemostasis-related factors synthetized by the liver. On that account, Swiss mice were injected with saline or BjV (1.6 mg/kg b.w, s.c.), and after 3, 6 and 24 h blood samples and liver fragments were collected to analyze mRNA expression by real-time qPCR. Increased gene expression of fibrinogen chains, haptoglobin and STAT3 was observed during envenomation, particularly at 3 and 6 h. At 24h, mRNA levels of F10 were raised, while those of Serpinc1, Proc and Adamts13 were diminished. Surprisingly, F3 mRNA levels were steadily decreased at 3 h. Gene expression of Thpo, F7, F5 Tfpi, Mug1 was unaltered. mRNA levels of Vwf, P4hb, F8, F2, Plg, and Serpinf2 were minimally altered, but showed important associations with Nfkb1 gene expression. In conclusion, snakebite envenomation upregulates hepatic mRNA synthesis particularly of fibrinogen chains, and acute-phase markers. This response explains the fast recovery of fibrinogen levels after antivenom administration to patients bitten by B. jararaca snakes.


Assuntos
Proteínas Sanguíneas/genética , Regulação da Expressão Gênica , Hemostasia/genética , Fígado/metabolismo , Mordeduras de Serpentes/metabolismo , Animais , Antivenenos/uso terapêutico , Transtornos da Coagulação Sanguínea , Bothrops/metabolismo , Modelos Animais de Doenças , Fibrinogênio/química , Fibrinogênio/genética , Fibrinogênio/metabolismo , Haptoglobinas/metabolismo , Hemorragia , Hemostáticos , Masculino , Camundongos , RNA Mensageiro/metabolismo , Fator de Transcrição STAT3/metabolismo , Mordeduras de Serpentes/sangue , Trombocitopenia , Fatores de Tempo , Fatores de Transcrição/genética
7.
Toxicon ; 184: 55-56, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32505639

RESUMO

The use of Fab antivenom (Crotalidae Polyvalent Immune Fab (Ovine) (CroFab); Boston Scientific) against North American Crotalidae envenomation is associated with the development of late- (≥4 days post-envenomation), new-onset of hematological abnormalities. Although attempts have been made to identify predictive indicators during the acute phase of an envenomation, of patients who are not at-risk of late-, new-onset of hematological abnormalities, there has been at least one prior report of a patient who developed thrombocytopenia that was unpredicted by current indicators. We add three cases of unpredicted, late-, new-onset of hematological abnormalities in patients with Fab-treated rattlesnake bite.


Assuntos
Antivenenos/uso terapêutico , Mordeduras de Serpentes/tratamento farmacológico , Trombocitopenia/induzido quimicamente , Afibrinogenemia/induzido quimicamente , Animais , Venenos de Crotalídeos , Crotalus , Humanos , Fragmentos Fab das Imunoglobulinas , Ovinos , Mordeduras de Serpentes/complicações
8.
Toxicon ; 184: 99-108, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32522619

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: In the region of Western Pará, Amazonia, Brazil, Philodendron megalophyllum is widely used for the treatment of envenomations caused by bites from venomous snakes. The traditional use of plants is usually done through oral administration of an infusion (decoction) soon after the bite occurs. The efficiency of aqueous extracts of P. megalophyllum was demonstrated for blocking the activity of the venom of Bothrops sp., but only for a pre-incubation protocol (venom:extract), which fails to simulate the real form of use of this species. In this context, the objective of this research was to evaluate the anti-snakebite potential of the aqueous extract of P. megalophyllum to inhibit for the biological activity induced by Bothrops atrox venom (BaV) using traditional treatment methods. MATERIAL AND METHODS: Initially, an aqueous extract using the stem of P. megalophyllum (AEPm) was prepared following the standard procedure used by the residents of the rural area along the Tapajós River (Eixo Forte region) in Santarém, PA, Brazil. The phytochemical profile of AEPm was conducted using thin layer chromatography (TLC) and phenolic compounds were quantified through colorimetric trials. The cytotoxicity of AEPm was evaluated using the MRC-5 human fibroblast line, and the antioxidant potential was measured using DPPH methods and cell culture. AEPm antimicrobial action was evaluated by the 96-well plate microdilution and the minimum inhibitory concentration (MIC) methods using 18 types of microorganisms including bacteria that are present in the oral cavity of snakes. AEPm blocking potential was tested against BaV activity in vitro (fibrinolytic) and in vivo (defibrinating and hemorrhagic). In order to test for an interaction between BaV and AEPm SDS-PAGE electrophoresis was conducted. RESULTS: The presence of coumarins, fatty acids, and hydrolysable tannins were detected in the AEPm. The colorimetric trials showed that AEPm had a high concentration of condensed tannins (20.1 ± 1.2%). The potential of AEPm for blocking of hemorrhagic and fibrinolytic activity of BaV showed a maximum reduction of 86.1% and 96.5%, respectively, for the pre-incubation protocol (1:10, venom:extract). However, when the extract was administered orally there was no significant blocking of these activities. The interaction of BaV and AEPm showed a modification of the profile of proteic bands when compared to the pattern of bands obtained from the BaV alone. The AEPm was not considered toxic, demonstrated antioxidant activity, and was capable of reducing the growth of 10 of the 18 studied microorganisms. CONCLUSION: Although the stem of P. megalophyllum is indicated by traditional medicine techniques as effective against snakebites, the extract, when tested orally was not able to significantly inhibit (p ˃ 0.05) hemorrhage and defibrinating activity induced by the B. atrox venom. On the other hand, the extract yielded a promising result with respect to antioxidant and antimicrobial potential, and after further studies it could be used as a complementary treatment for localized action and secondary infections that frequently occur with snakebites from the genus of Bothrops sp.


Assuntos
Antibacterianos/uso terapêutico , Extratos Vegetais/uso terapêutico , Mordeduras de Serpentes/tratamento farmacológico , Animais , Antibacterianos/farmacologia , Antioxidantes/farmacologia , Antioxidantes/uso terapêutico , Antivenenos/uso terapêutico , Venenos de Crotalídeos , Hemorragia/tratamento farmacológico , Humanos , Medicina Tradicional , Philodendron , Extratos Vegetais/farmacologia
9.
PLoS Negl Trop Dis ; 14(6): e0008430, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32555599

RESUMO

BACKGROUND: Data on incidence of snakebites and the responsible snake species are largely missing in Vietnam and comprehensive national guidelines for management of snakebite envenoming are not yet available. They are needed to estimate the scope of this health problem, to assess the demand for snake antivenom and to ensure the best possible treatment for snakebite victims. METHODOLOGY/PRINCIPLE FINDINGS: A cross-sectional community-based survey was conducted from January to April 2018. Multistage cluster sampling was applied and snakebite incidence in Can Tho municipality, excluding two central districts of Can Tho city, was calculated at 48 (95%-confidence interval (CI): 20.5-99.8) snakebites per 100,000 person-years. Seven snakebite victims found during the survey reported 3 bites from green pit vipers and 4 bites from non-venomous snakes. In 2017 two treatment centres for snakebite envenoming in Can Tho city, the Military Hospital 121 and the Paediatric Hospital, received 520 admissions of snakebite victims. Two hundred sixty-seven came from Can Tho Municipality and 253 from neighbouring provinces. According to these data, the incidence of snakebites for Can Tho municipality was calculated at 21 (95%-CI: 18.5-23.7) snakebites per 100,000 person-years. Incidence was 14 (95%-CI: 12-17) snakebites per 100,000 person years in those 7 districts of the municipality which were part of the community survey. Green pit vipers were responsible for 92% of snakebite envenoming. Antivenom, antibiotics and corticosteroids were administered to 405 (90%), 379 (84%), and 310 (69%) out of 450 patients, respectively. CONCLUSIONS: Incidence of snakebites in Can Tho Municipality is relatively low and green pit vipers are responsible for the vast majority of bites. Approximately one third of snakebite patients sought medical care in hospitals and although hospital data still underestimate the real incidence of snakebites, these statistics are valuable and can be obtained fast and inexpensively. Evaluation of patients' records indicates the need for development of guidelines for management of snakebite envenoming in Vietnam to ensure a rational use of antivenom and ancillary treatments.


Assuntos
Mordeduras de Serpentes/epidemiologia , Serpentes/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Antibacterianos/sangue , Antivenenos/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Mordeduras de Serpentes/terapia , Inquéritos e Questionários , Vietnã/epidemiologia , Adulto Jovem
10.
Rev Med Suisse ; 16(693): 984-988, 2020 May 13.
Artigo em Francês | MEDLINE | ID: mdl-32401438

RESUMO

Sea bathing is often a priority activity for travelers, with widely recognized health benefits. The dangers, in contrast, are underestimated, especially in tropical seas. We describe the scope of marine envenoming, trauma, and infections, representing 1-3 % of tropical and travel medicine consultations in the literature. Our review includes the eco-epidemiology, clinical approach, and prevention of envenoming by invertebrates (jellyfish, anemone, sea-urchin, starfish, octopus, sea cone) and some vertebrates (stingrays, stone fish, snakes). We include penetrating trauma (by stingray, stonefish, sea urchin, coral) and infections (mycobacteria, marine bacteria). Eating-related dangers (ciguatera, fugu, parasites) are not described here. We also present antidotes, antivenoms, and first-aid.


Assuntos
Praias , Mordeduras e Picadas/epidemiologia , Mordeduras e Picadas/terapia , Infecções/epidemiologia , Infecções/terapia , Natação , Animais , Antídotos/administração & dosagem , Antídotos/uso terapêutico , Antivenenos/administração & dosagem , Antivenenos/uso terapêutico , Primeiros Socorros , Humanos , Medicina de Viagem , Doença Relacionada a Viagens
11.
Toxicon ; 181: 36-44, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32330462

RESUMO

BACKGROUND: Venom-induced consumption coagulopathy (VICC) from tiger snake (Notechis scutatus) envenomation results in a dose-dependent coagulopathy that is detectable on coagulometry. However, individual coagulation factor activities in dogs with tiger snake envenomation have not been determined. This study aimed to characterise VICC and the time course of recovery in tiger snake envenomed dogs and to investigate an association between tiger snake venom (TSV) concentrations and factor activity. METHODS: This was a prospective, observational, cohort study. The study cohort was 11 dogs of any age, breed, sex, body weight >10 kg, confirmed serum TSV on ELISA and treated with antivenom. Blood was collected at enrolment before antivenom administration, then at 3, 12 and 24 h after antivenom administration. Tiger snake venom concentrations were detected with a sandwich ELISA. Fibrinogen was measured using a modified Clauss method, and coagulation factors (F) II, V, VII, VIII and X were measured with factor-deficient human plasma using a modified prothrombin (PT) and activated partial thromboplastin (aPTT) method. Linear mixed models, with multiple imputations of censored observations, were used to determine the effect of time and TSV concentration on the coagulation times and factor activity. This cohort was compared to 20 healthy controls. RESULTS: At enrolment, there were severe deficiencies in fibrinogen, FV and FVIII, with predicted recovery by 10.86, 11.75 and 13.14 h after antivenom, respectively. There were modest deficiencies in FX and FII, with predicted recovery by 20.57 and 32.49 h after antivenom, respectively. No changes were detected in FVII. Prothrombin time and aPTT were markedly prolonged with predicted recovery of aPTT by 12.58 h. Higher serum TSV concentrations were associated with greater deficiencies in FII, FV and FVIII, and greater prolongations in coagulation times. The median (range) serum TSV concentration was 57 (6-2295) ng/mL. CONCLUSIONS: In tiger snake envenomed dogs, we detected a profound, TSV-concentration-related consumption of select coagulation factors, that rapidly recovered toward normal. These findings allowed further insight into tiger snake VICC in dogs.


Assuntos
Venenos Elapídicos/toxicidade , Mordeduras de Serpentes/veterinária , Animais , Antivenenos/uso terapêutico , Fatores de Coagulação Sanguínea , Coagulação Intravascular Disseminada/induzido quimicamente , Coagulação Intravascular Disseminada/veterinária , Doenças do Cão , Cães
12.
Asian Cardiovasc Thorac Ann ; 28(4): 213-215, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32276541

RESUMO

Cardiac complications following envenomation by Russell's viper venom are uncommon. We describe a 14-year-old girl who developed delayed-onset sinus node dysfunction. She presented with mucosal bleeding, ptosis, and muscle weakness. Her 20-min whole blood clotting time and international normalized ratio were prolonged. The initial electrocardiogram showed sinus tachycardia. Her systemic manifestations responded to antivenom serum. After 24 h, she developed bradycardia and electrocardiography showed sinus node dysfunction with sinus arrest and an atrial escape rhythm. This case shows that arrhythmias can have a delayed onset even after resolution of other systemic manifestations, and even after treatment with antivenom serum.


Assuntos
Frequência Cardíaca , Víbora de Russell , Síndrome do Nó Sinusal/etiologia , Nó Sinoatrial/fisiopatologia , Mordeduras de Serpentes/complicações , Potenciais de Ação , Adolescente , Animais , Antivenenos/uso terapêutico , Eletrocardiografia , Feminino , Humanos , Síndrome do Nó Sinusal/diagnóstico , Síndrome do Nó Sinusal/fisiopatologia , Mordeduras de Serpentes/sangue , Mordeduras de Serpentes/diagnóstico , Mordeduras de Serpentes/terapia , Fatores de Tempo
14.
Wilderness Environ Med ; 31(2): 174-180, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32331950

RESUMO

INTRODUCTION: Depending on their theatre of operation, French soldiers may potentially be exposed to scorpion stings and snakebites. Following the recommendations of a French military health service (FMHS) technical committee for envenomation, the FMHS provides antivenoms appropriate to each deployment. This work aimed to evaluate this risk of envenomation and to assess the antivenoms used by the FMHS in operational theatres since the creation of this committee in 2015. METHODS: Cases were identified based on a review of temporary authorization of use application forms for the use of antivenom. Data were collected retrospectively from these forms, and prescribing physicians were contacted for any missing data. RESULTS: Between 2015 and 2017, 28 requests for temporary authorization of use were identified: 19 for Scorpifav (Sanofi-Pasteur, Lyon, France) and 9 for Fav-Afrique (Sanofi-Pasteur). The FMHS treated 15 soldiers and 4 civilians for scorpion envenomation with Scorpifav: 15 in Mali, 3 in Chad, and 1 in Niger. Systemic signs were observed in 7 patients. Two soldiers and 7 civilians were treated with Fav-Afrique for ophidian envenomation: 5 in Djibouti, 3 in Mali, and 1 in the Republic of Côte d'Ivoire. These 28 patients were treated without sequelae. Other than moderate erythema that resolved with an antihistamine, no adverse effects were reported. Medical evacuation to France was unnecessary. CONCLUSIONS: This study shows that the risk of envenomation for soldiers on deployment is low but real. Antivenoms used by the FMHS were efficient and well tolerated, preserving the operational capacity of deployed troops.


Assuntos
Antivenenos/uso terapêutico , Militares/estatística & dados numéricos , Picadas de Escorpião/terapia , Mordeduras de Serpentes/terapia , Adulto , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Militar , Fatores de Risco , Picadas de Escorpião/epidemiologia , Mordeduras de Serpentes/epidemiologia , Adulto Jovem
15.
Pediatr Emerg Med Pract ; 17(4): 1-24, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32192283

RESUMO

Marine envenomations can cause a diverse array of clinical syndromes. Systemic and life-threatening reactions, as well as delayed presentations, can occur. The pediatric population is at higher risk for serious reactions to envenomations because their greater body surface area and smaller body mass can lead to a higher relative venom load. Although the majority of the literature on marine envenomations is of low quality, the available literature does suggest that management varies depending on the geographic location. This issue reviews both common and life-threatening presentations of marine envenomations, highlights key aspects of the history and physical examination that will help narrow the differential, and offers recommendations for management based on the envenomating creature and geographic location.


Assuntos
Mordeduras e Picadas/diagnóstico , Mordeduras e Picadas/terapia , Toxinas Marinhas/envenenamento , Ácido Acético/uso terapêutico , Antibacterianos/uso terapêutico , Antivenenos/uso terapêutico , Mordeduras e Picadas/complicações , Criança , Pré-Escolar , Procedimentos Clínicos , Diagnóstico Diferencial , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Anamnese , Dor/etiologia , Manejo da Dor , Exame Físico , Irrigação Terapêutica
16.
J Vet Emerg Crit Care (San Antonio) ; 30(3): 286-294, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32112523

RESUMO

OBJECTIVE: To examine the efficiency of hemoperfusion in removing South American rattlesnake (Crotalus durissus terrificus) venom from rats compared with neutralization by antivenom. DESIGN: An exploratory experimental investigation in rats involving the injection of snake venom with or without subsequent hemoperfusion or antivenom administration. SETTING: Basic animal research laboratory in a private university. ANIMALS: Normal, healthy male Wistar rats (0.29-0.40 kg, 3-6 months old) from a commercial breeder. INTERVENTIONS: Four experimental groups of randomly allocated rats (n = 3/group) were studied: Group 1: rats were injected with a single dose of venom (5 mg/kg, IM, in the right thigh) with no other treatment; blood samples were collected minutes before death to determine leukocyte, platelet, and erythrocyte counts; Group 2 (Control): rats underwent hemoperfusion alone for 60 min using a hemoperfusion cartridge designed for protein adsorption (by granulated charcoal) and protein precipitation (by tannic acid); Group 3 (Venom + antivenom): rats were injected with venom (5 mg/kg, IM) and, 10 min later, were treated with antivenom at the venom:antivenom ratio recommended by the manufacturer; Group 4 (Venom + hemoperfusion): Rats were injected with venom (5 mg/kg, IM) and, 10 min later, were hemoperfused for 60 min. In groups 2-4, blood samples were collected for leukocyte, platelet, and erythrocyte counts 24 h after venom. MEASUREMENTS AND MAIN RESULTS: Rats injected with venom alone (Group 1) developed signs of neurotoxicity and ataxia and died in 9.0 ± 0.43 h but showed no changes in leukocyte or erythrocyte counts. In contrast, there were no deaths in groups 2-4. The lack of deaths in Groups 3 and 4 indicated that antivenom and hemoperfusion, respectively, protected against the lethal effects of the venom. CONCLUSIONS: Hemoperfusion with a double-action hemoperfusion cartridge capable of protein adsorption and precipitation protected rats against C. d. terrificus venom.


Assuntos
Venenos de Crotalídeos , Hemoperfusão/métodos , Animais , Antivenenos/uso terapêutico , Plaquetas/efeitos dos fármacos , Crotalus , Masculino , Ratos , Ratos Wistar
17.
PLoS Negl Trop Dis ; 14(2): e0008054, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32032357

RESUMO

Naja atra envenomation is one of the most significant clinical snakebite concerns in Taiwan. Taiwanese freeze-dried neurotoxic antivenom (FNAV) is currently used clinically for the treatment of cobra snakebite, and has been shown to limit the mortality of cobra envenomation to less than 1%. However, more than half of victims (60%) require surgery because of local tissue necrosis, a major problem in patients with cobra envenomation. Although the importance of evaluating the neutralizing effect of FNAV on this pathology is recognized, whether FNAV is able to prevent the local necrosis extension induced by N. atra venom has not been investigated in detail. Cytotoxins (CTXs) are considered as the major components of N. atra venom that cause necrosis. In the current study, we isolated CTXs from whole cobra venom and used both whole venom and purified CTXs to develop animal models for assessing the neutralization potential of FNAV against venom necrotizing activity. Local necrotic lesions were successfully produced in mice using CTXs in place of whole N. atra venom. FNAV was able to rescue mice from a subcutaneously injected lethal dose of cobra venom; however, it was unable to prevent CTX-induced dermo-necrosis. Furthermore, using the minimal necrosis dose (MND) of CTXs and venom proteome data, we found a dose of whole N. atra venom suitable for FNAV and developed a workable protocol for inducing local necrosis in rodent models that successfully imitated the clinical circumstance of cobra envenoming. This information provides a more comprehensive understanding of the pathophysiology of N. atra envenomation, and serves as a guide for improving current antivenom strategies and advancing clinical snakebite management in Taiwan.


Assuntos
Antivenenos/uso terapêutico , Venenos Elapídicos/toxicidade , Naja naja , Necrose/induzido quimicamente , Animais , Citotoxinas/química , Citotoxinas/toxicidade , Venenos Elapídicos/química , Camundongos , Camundongos Endogâmicos ICR , Taiwan
18.
Toxicon ; 177: 41-45, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32056833

RESUMO

Green pit viper (Trimeresurus sp.) bite occurred throughout Myanmar, but there is no specific antivenom produced in the country for related envenomation. Instead, Myanmar Russell's viper antivenom (Anti-MRV) was often misused because of prolonged clotting time was observed from both species. Thai green pit viper antivenom (Anti-TGPV) raised against Trimeresurus albolabris was found to be effective against venoms of more than ten Trimeresurus sp. from Thailand, Malaysia and Indonesia. The present study compared the neutralization capacities of Anti-TGPV and Anti-MRV towards the venom from T. erythrurus from Myanmar. Anti-TGPV was more efficacious than Anti-MRV in cross-neutralizing the lethal and haemorrhagic activities of the venom by a potency of a least 1.4 times higher. Although Anti-TGPV effectively cross-neutralized the coagulation activity of the venom, Anti-MRV failed to do so. Immunodiffusion and immunoblot experiments showed that Anti-TGPV cross-reacted with more protein components of the venom than Anti-MRV. In conclusion, Anti-TGPV is a better choice for patients bitten by Myanmar green pit viper, but further clinical investigation is required. The current findings highlight the development of a specific antivenom against Myanmar green pit viper venom.


Assuntos
Antivenenos/uso terapêutico , Venenos de Crotalídeos , Mordeduras de Serpentes/tratamento farmacológico , Trimeresurus , Animais , Testes de Coagulação Sanguínea , Reações Cruzadas , Humanos , Tailândia
19.
Buenos Aires; GCBA. Gerencia Operativa de Epidemiología; 20 ene. 2020. a) f: 31 l:36 p. graf.(Boletín Epidemiológico Semanal: Ciudad Autónoma de Buenos Aires, 2, 22).
Monografia em Espanhol | LILACS, InstitutionalDB, BINACIS, UNISALUD | ID: biblio-1104325

RESUMO

Presentación de un caso, notificado el 9 de enero de 2017, a la Gerencia Operativa de Epidemiología del Gobierno de la Ciudad de Buenos Aires por un efector privado de la Ciudad, de envenenamiento por animal ponzoñoso (Alacranismo) en un paciente residente en la Ciudad de Buenos Aires. Se describen el cuadro clínico y el tratamiento recibido, la evolución del caso, la importancia de distintas acciones de vigilancia epidemiológica, el procedimiento de notificación, medidas de protección, y medidas de prevención y control de accidentes. Incluye datos de centros públicos nacionales y de la Ciudad de Buenos Aires especializados en asistencia y/o in-formación sobre animales venenosos


Assuntos
Humanos , Animais , Criança , Adulto , Escorpiões/patogenicidade , Antivenenos/administração & dosagem , Antivenenos/uso terapêutico , Picadas de Escorpião/complicações , Picadas de Escorpião/patologia , Picadas de Escorpião/prevenção & controle , Picadas de Escorpião/terapia , Picadas de Escorpião/epidemiologia , Prevenção de Acidentes/instrumentação , Prevenção de Acidentes/métodos , Animais Venenosos
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