The timing is right to end snakebite deaths in South Asia

Ralph, Ravikar; Sharma, Sanjib Kumar; Faiz, Mohammad Abul; Ribeiro, Isabela; Rijal, Suman; Chappuis, François; Kuch, Ulrich

doi:10.1136/bmj.k5317

Cited by 54 publications

(69 citation statements)

References 53 publications

(90 reference statements)

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“…To meet the requirement of antivenoms, snake antivenom sera are presently also imported from India. However, studies have shown that Indian antivenoms provide partial neutralization, particularly for N. naja venom [ 14 , 15 , 16 ]. Although, N. naja and N. oxiana are also prevalent in India, but the venom composition is known to vary within the same species, due to change in geographical and ecological factors [ 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Proteomic Investigations of Two Pakistani Naja Snake Venoms Species Unravel the Venom Complexity, Posttranslational Modifications, and Presence of Extracellular Vesicles

Manuwar

Dreyer

Böhmert

et al. 2020

Toxins

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Latest advancement of omics technologies allows in-depth characterization of venom compositions. In the present work we present a proteomic study of two snake venoms of the genus Naja i.e., Naja naja (black cobra) and Naja oxiana (brown cobra) of Pakistani origin. The present study has shown that these snake venoms consist of a highly diversified proteome. Furthermore, the data also revealed variation among closely related species. High throughput mass spectrometric analysis of the venom proteome allowed to identify for the N. naja venom 34 protein families and for the N. oxiana 24 protein families. The comparative evaluation of the two venoms showed that N. naja consists of a more complex venom proteome than N. oxiana venom. Analysis also showed N-terminal acetylation (N-ace) of a few proteins in both venoms. To the best of our knowledge, this is the first study revealing this posttranslational modification in snake venom. N-ace can shed light on the mechanism of regulation of venom proteins inside the venom gland. Furthermore, our data showed the presence of other body proteins, e.g., ankyrin repeats, leucine repeats, zinc finger, cobra serum albumin, transferrin, insulin, deoxyribonuclease-2-alpha, and other regulatory proteins in these venoms. Interestingly, our data identified Ras-GTpase type of proteins, which indicate the presence of extracellular vesicles in the venom. The data can support the production of distinct and specific anti-venoms and also allow a better understanding of the envenomation and mechanism of distribution of toxins. Data are available via ProteomeXchange with identifier PXD018726.

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Section: Introductionmentioning

confidence: 99%

Proteomic Investigations of Two Pakistani Naja Snake Venoms Species Unravel the Venom Complexity, Posttranslational Modifications, and Presence of Extracellular Vesicles

Manuwar

Dreyer

Böhmert

et al. 2020

Toxins

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“…Cerastes gasparetti (7) Boiga sp. (4) Cerastes vipera (1) Boiga trigonata (4) Daboia russelii (985) Chrysopelea ornata (1) Daboia siamensis (383) Chrysopelea pelias (1) Echis carinatus (229) Coelognathus helena (5) Echis coloratus (5) Coelognathus radiatus (4) Hydrophis cyanocinctus (2) Cylindrophis maculatus (1) Hydrophis platurus (2) Cylindrophis ruffus (NR) Naja spp.…”

Section: Africamentioning

confidence: 99%

“…(4) Cerastes vipera (1) Boiga trigonata (4) Daboia russelii (985) Chrysopelea ornata (1) Daboia siamensis (383) Chrysopelea pelias (1) Echis carinatus (229) Coelognathus helena (5) Echis coloratus (5) Coelognathus radiatus (4) Hydrophis cyanocinctus (2) Cylindrophis maculatus (1) Hydrophis platurus (2) Cylindrophis ruffus (NR) Naja spp. (8) Lycodon striatus (15) Naja sumatrana (1) Malpolon moilensis (4) Ovophis monticola (1) « non-venomous snakes » (53) Rhabdophis subminiatus (5) Oligodon arnensis (7) Trimeresurus albolabris (344) Oligodon cyclurus (NR) Trimeresurus gramineus (20) Oligodon spp (7) Trimeresurus kanburiensis (1) Oligodon taeniatus (NR) Trimeresurus macrops (23) Oligodon taeniolatus (2) Trimeresurus malabaricus (26) Pareas carinatus (NR) Trimeresurus purpureomaculatus (3) Psammodynastes pulverulentus (2) Trimeresurus spp. (36) Ptyas mucosa (13) Trimeresurus trigonocephalus (19) Ptyas spp.…”

Section: Africamentioning

confidence: 99%

“…For this, understanding what type of snakes and associated snake bites occur where is crucial, yet this depends first on the taxonomic identification (identification hereafter; i.e. family, genus and species) of these snakes [5][6][7]. At the clinical level, the identity of the biting snake (BSN) can help healthcare providers anticipate victims' syndromes and support decision making when treating the patient (i.e.…”

Section: Introductionmentioning

confidence: 99%

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Identifying the snake: First scoping review on practices of communities and healthcare providers confronted with snakebite across the world

et al. 2020

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Background Snakebite envenoming is a major global health problem that kills or disables half a million people in the world's poorest countries. Biting snake identification is key to understanding snakebite eco-epidemiology and optimizing its clinical management. The role of snakebite victims and healthcare providers in biting snake identification has not been studied globally. Objective This scoping review aims to identify and characterize the practices in biting snake identification across the globe. Methods Epidemiological studies of snakebite in humans that provide information on biting snake identification were systematically searched in Web of Science and Pubmed from inception to 2 nd February 2019. This search was further extended by snowball search, hand searching literature reviews, and using Google Scholar. Two independent reviewers screened publications and charted the data. Results We analysed 150 publications reporting 33,827 snakebite cases across 35 countries. On average 70% of victims/bystanders spotted the snake responsible for the bite and 38% captured/killed it and brought it to the healthcare facility. This practice occurred in 30 countries with both fast-moving, active-foraging as well as more secretive snake species. Methods for identifying biting snakes included snake body examination, victim/bystander biting snake description, interpretation of clinical features, and laboratory tests. In nine publications, a

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“…O soro liofilizado não necessita de cadeia de frio. Na Índia, são disponibilizadas as duas apresentações de antiveneno, sendo que a liofilizada permite que o tratamento seja realizado nas zonas mais distantes do país, onde não há cadeia de frio 32 . O retardo no tratamento soroterápico pode aumentar os riscos de complicações, particularmente de insuficiência renal aguda, agravando o quadro clínico e piorando seu prognóstico, podendo evoluir com sequelas e a óbito 27 .…”

Section: Descrição Do Casounclassified

Envenenamento por Crotalus durissus marajoensis em Muaná, Ilha de Marajó, estado do Pará, Brasil

Faro

Coutinho

Gadelha

et al. 2020

Revista Pan-Amazônica de Saúde

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anos de idade, picado por cascavel no tornozelo direito quando caminhava em área de campo. Após o envenenamento, relatou parestesia sem dor local. Em seguida, apresentou sensação de peso na cabeça, dificuldade de abrir as pálpebras, disartria, visão turva e diplopia. Deu entrada no Hospital Municipal de Muaná, 9 h após a picada, com os sinais e sintomas referidos, acrescidos de náuseas, tontura, dificuldade de deambular e mialgia. Devido à ausência do antiveneno específico no hospital do município, o paciente foi encaminhado para o Pronto Socorro Municipal em Belém do Pará, onde chegou após 18 h do acidente, apresentando fácies neurotóxica, midríase, colúria e oligúria. O caso foi classificado como envenenamento grave e aplicado o antiveneno específico. Após quatro dias, o paciente foi transferido para o Hospital Universitário João de Barros Barreto, com evidência de neurotoxicidade, onde foram realizadas medidas de suporte clínico e exames laboratoriais. Foram observadas alterações no hemograma, no coagulograma, nos níveis de ureia, creatinina, transaminases e creatinofosfoquinase, evidenciando rabdomiólise. Apesar do tratamento soroterápico e de suporte clínico terem sido realizados tardiamente, houve evolução para a cura clínica. CONCLUSÃO: Ressalta-se a importância da soroterapia precoce e a raridade do envenenamento por essa subespécie, cujas características clínicas são as mesmas dos demais acidentes crotálicos relatados no Brasil.

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The timing is right to end snakebite deaths in South Asia

Abstract: Regional collaboration is crucial to end preventable deaths and disability from snakebites in South Asia, say Ravikar Ralph and colleagues

Cited by 54 publications

References 53 publications

Proteomic Investigations of Two Pakistani Naja Snake Venoms Species Unravel the Venom Complexity, Posttranslational Modifications, and Presence of Extracellular Vesicles

Proteomic Investigations of Two Pakistani Naja Snake Venoms Species Unravel the Venom Complexity, Posttranslational Modifications, and Presence of Extracellular Vesicles

Identifying the snake: First scoping review on practices of communities and healthcare providers confronted with snakebite across the world

Envenenamento por Crotalus durissus marajoensis em Muaná, Ilha de Marajó, estado do Pará, Brasil

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