Envenoming by king cobras (Ophiophagus hannah) in Vietnam with cardiac complications and necrotizing fasciitis

Le, Hung Quoc; Ngan, Nguyen Thi Thuy; Vo, Tho Ngoc Anh; Nguyen, Thuan; Ngoc, Khanh Thi; Ho, Thanh Thi Chi; Nguyen, Sang Ngoc; Phan, Xuan Thi; Nguyen, Duy Ly Minh; Kieu, Dung Ngoc; Ngo, Hiep Duc; Warrell, David A.

doi:10.1016/j.toxicon.2021.07.007

Cited by 4 publications

(2 citation statements)

References 15 publications

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“…Nevertheless, there are cases with pronounced cardiotoxic effects [39,40]. At the same time, as a result of therapy directed primarily against neurotoxic components, the significance of cardiotoxic effects increases [41]. This leads to the idea that the identification of the most active cardiotoxins can be useful in understanding the species specificity of the development of the pathological effects of cobra envenomation and can provide an additional criterion for evaluating the effectiveness of antivenoms.…”

Section: Discussionmentioning

confidence: 99%

Effects of Cobra Cardiotoxins on Intracellular Calcium and the Contracture of Rat Cardiomyocytes Depend on Their Structural Types

Аверин

Berezhnov

Pimenov

et al. 2023

IJMS

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Cardiotoxins (CaTx) of the three-finger toxin family are one of the main components of cobra venoms. Depending on the structure of the N-terminal or the central polypeptide loop, they are classified into either group I and II or P- and S-types, respectively, and toxins of different groups or types interact with lipid membranes variably. While their main target in the organism is the cardiovascular system, there is no data on the effects of CaTxs from different groups or types on cardiomyocytes. To evaluate these effects, a fluorescence measurement of intracellular Ca2+ concentration and an assessment of the rat cardiomyocytes’ shape were used. The obtained results showed that CaTxs of group I containing two adjacent proline residues in the N-terminal loop were less toxic to cardiomyocytes than group II toxins and that CaTxs of S-type were less active than P-type ones. The highest activity was observed for Naja oxiana cobra cardiotoxin 2, which is of P-type and belongs to group II. For the first time, the effects of CaTxs of different groups and types on the cardiomyocytes were studied, and the data obtained showed that the CaTx toxicity to cardiomyocytes depends on the structures both of the N-terminal and central polypeptide loops.

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Section: Discussionmentioning

confidence: 99%

Effects of Cobra Cardiotoxins on Intracellular Calcium and the Contracture of Rat Cardiomyocytes Depend on Their Structural Types

Аверин

Berezhnov

Pimenov

et al. 2023

IJMS

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“…The etiology of rhabdomyolysis included sepsis, polytrauma, necrotizing fasciitis, heatstroke, PRIS, snakebite, and mushroom poisoning and all patients had multi-organ dysfunction, including renal dysfunction requiring continuous renal replacement therapy. Various modalities were used for myoglobin clearance, with the most common being plasmapheresis/therapeutic plasma exchange (nine studies), coupled plasma filtration-absorption (1 study, n=4; Pezzi et al), high flux dialyzer (1 study, n=6; Sorrenti), super high flux membrane (n=1; Naka), and the Cytosorb system, which is a hemoadsorption cartridge added to the hemodialysis circuit (three studies, n=3) [7][8][9][10][11][12][13][14][15][16][17]. On the other hand, several case reports and case series published during this time did not use any modality for myoglobin clearance and used supportive care and other treatments [18][19][20][21][22][23][24][25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Plasma Exchange in Severe Rhabdomyolysis: A Case-Control Study

Boparai¹,

Lakra²,

Dhaliwal³

et al. 2023

Cureus

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Introduction: Rhabdomyolysis is a serious condition that can cause acute kidney injury (AKI), compartment syndrome, severe metabolic and electrolyte derangement leading to arrhythmias, and even death. Total plasma exchange (TPE) has been used as a treatment modality to clear myoglobin, but the evidence is limited. In this study, we aim to investigate the use of TPE in critically ill rhabdomyolysis patients.Methods: We retrospectively chart reviewed adult patients admitted to the intensive care unit (ICU) with a diagnosis of rhabdomyolysis between 2012 and 2021. We dichotomized patients into two groups based on whether TPE was used or not in addition to standard care. PRISMA machines with TPE2000 filters and either 5% albumin or fresh frozen plasma were used in the TPE group.Results: The patients' age ranged from 23 years to 87 years (mean 49.4, SD 18.1), and 51% were male. Initial creatinine ranged from 0.6 to 16mg/dL (mean 3.4, SD 2.7), creatinine phosphokinase (CPK) from 403-93,232 U/L, and myoglobin from 934 to >20,000. The Sequential Organ Failure Assessment (SOFA)scores on admission ranged from 6 to 17 (mean 7.23, SD 3.40). Overall, 28.78% (N=19) of the patients received therapeutic plasma exchange. The overall mortality in our study was 31.9%, with the length of ICU stay ranging from 1-25 days (mean 7.10, SD 5.91) among survivors. Older age and the presence of shock were predictive of mortality in univariate and multivariate analyses. There was no statistically significant association in mortality between the TPE and non-TPE groups (36.84% in TPE vs. 36.17% in the non-TPE group, OR 0.7209, p=0.959). Only two patients in the non-TPE group developed CKD/ESRD on long-term follow-up. Conclusion: Our study showed that TPE administration in critically ill patients with rhabdomyolysis did not improve mortality or length of ICU stay. Further studies are required to elucidate its indication and effect on long-term renal outcomes.

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Clinical aspects of snakebite envenoming and its treatment in low-resource settings

Warrell¹,

Williams²

2023

The Lancet

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Envenoming by king cobras (Ophiophagus hannah) in Vietnam with cardiac complications and necrotizing fasciitis

Cited by 4 publications

References 15 publications

Effects of Cobra Cardiotoxins on Intracellular Calcium and the Contracture of Rat Cardiomyocytes Depend on Their Structural Types

Effects of Cobra Cardiotoxins on Intracellular Calcium and the Contracture of Rat Cardiomyocytes Depend on Their Structural Types

Therapeutic Plasma Exchange in Severe Rhabdomyolysis: A Case-Control Study

Clinical aspects of snakebite envenoming and its treatment in low-resource settings

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