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Shewale AD, Mishra D, Tiwari S, Nale TN, Kuwatada J, Khandelwal N. Implementing Interventions Under "National Action Plan for Snakebite Envenoming (NAPSE) in India": Challenges, Lessons Learnt and Way Forward for Stakeholders Participatory Approach. Trop Med Infect Dis 2025; 10:132. [PMID: 40423362 DOI: 10.3390/tropicalmed10050132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Revised: 04/15/2025] [Accepted: 04/30/2025] [Indexed: 05/28/2025] Open
Abstract
Snakebite envenoming remains a critical yet underrecognized public health issue, particularly in tropical and subtropical regions, with India bearing nearly half of the global burden of snakebite-related deaths. Despite its significant impact, underreporting, delayed medical intervention, and insufficiently trained healthcare professionals continue to exacerbate the problem. In response, the Government of India launched the National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE) in March 2024, aiming to halve snakebite-related deaths by 2030. Key challenges during the development and implementation of NAPSE included the limited multisectoral engagement initially, variations in state-level capacities, and logistical barriers in reaching remote populations. Lessons learned include the value of early stakeholder consultations, the importance of inter-ministerial collaboration, and the need for continuous community engagement. This comprehensive strategy emphasizes strengthening surveillance systems, enhancing anti-snake venom (ASV) distribution and quality, improving healthcare infrastructure, and promoting community awareness through a One Health approach. The plan also addresses critical challenges such as inadequate training at primary healthcare levels, inconsistent ASV supply, and inefficient emergency referral systems. By fostering multisectoral collaboration and targeted interventions, such as strengthening Regional Venom Centres and establishing Poison Information Centre, targeted training, and awareness campaigns, NAPSE aims to reduce mortality and disability associated with snakebite envenoming, aligning with global health objectives and setting an example for regional efforts in Southeast Asia.
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Affiliation(s)
- Ajit Dadaji Shewale
- Centre for One Health, National Centre for Disease Control, Ministry of Health & Family Welfare, New Delhi 110074, India
| | - Dipti Mishra
- Centre for One Health, National Centre for Disease Control, Ministry of Health & Family Welfare, New Delhi 110074, India
| | - Simmi Tiwari
- Centre for One Health, National Centre for Disease Control, Ministry of Health & Family Welfare, New Delhi 110074, India
| | - Tushar Nanasaheb Nale
- Centre for One Health, National Centre for Disease Control, Ministry of Health & Family Welfare, New Delhi 110074, India
| | - Jitesh Kuwatada
- Centre for One Health, National Centre for Disease Control, Ministry of Health & Family Welfare, New Delhi 110074, India
| | - Nidhi Khandelwal
- Centre for One Health, National Centre for Disease Control, Ministry of Health & Family Welfare, New Delhi 110074, India
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Talukdar A, Giri S, Doley R. Kraits of Indian subcontinent: Natural history, risks, venom variation, lethality and treatment strategies - A comprehensive review. Toxicon 2025; 262:108406. [PMID: 40374096 DOI: 10.1016/j.toxicon.2025.108406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2025] [Revised: 04/30/2025] [Accepted: 05/11/2025] [Indexed: 05/17/2025]
Abstract
The World Health Organization (WHO) has re-classified "Snakebite" as a Neglected Tropical Disease in 2017, and estimated that as many as 5.4 million people suffer from snakebites every year. Out of this large number of snakebites, envenoming occurs in about 50 % of the cases, and the number of resulting deaths could be as high as 138,000. The genus Bungarus commonly known as kraits are medically important elapid snakes widely distributed in the Indian subcontinent, southern China and the Southeast Asian countries (except Philippines). The Indian subcontinent (India, Bangladesh, Bhutan, Nepal, Pakistan, Sri Lanka and Maldives) is home to 8-9 krait species, among which B. caeruleus and B. niger are highly venomous. This review presents the current state of knowledge on krait bites in the Indian subcontinent. The risk of envenomation by kraits, the venom lethality and krait bite management in the Indian subcontinent have been critically analyzed. Moreover, the issue of dry bites from kraits and their management has also been reviewed. Furthermore, critical aspects, such as knowledge of snakebite management among healthcare workers, clinical symptoms of snakebite patients, and treatment in healthcare facilities including antivenom administration and their clinical efficacy, have helped us in identifying the critical knowledge gaps. Proposed preventive measures will help to reduce krait bite associated mortality and morbidity. Moreover, development and accessibility to affordable treatment options may help in the effective management of krait bites.
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Affiliation(s)
- Amit Talukdar
- Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, Assam, 784028, India
| | - Surajit Giri
- Demow Rural Government Community Health Centre, Raichai, Konwar Dihingia Gaon, Sivasagar, Assam, India
| | - Robin Doley
- Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, Assam, 784028, India.
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Pavuluri LA, Bitla AR, Vishnubotla SK, Rapur R. Oxidative Stress, DNA Damage, Inflammation and Endothelial Dysfunction in Snakebite-Induced Acute Kidney Injury. Indian J Nephrol 2025; 35:349-354. [PMID: 40352896 PMCID: PMC12065592 DOI: 10.25259/ijn_545_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/04/2024] [Indexed: 05/14/2025] Open
Abstract
Background Snakebite-induced acute kidney injury (SAKI) is a life-threatening complication. Despite its impact on public health, the understanding of the underlying cellular and molecular mechanisms remains limited. There is a lack of studies investigating the role of oxidative stress, oxidative deoxyribonucleic acid (DNA) damage, inflammation, and endothelial dysfunction in SAKI. This study aims to address this knowledge gap. Materials and Methods Biomarkers of oxidative stress, including oxidative DNA damage, inflammation, and endothelial dysfunction were assessed in 30 patients with SAKI and 30 healthy controls. Malondialdehyde (MDA), protein carbonyl content (PCC), advanced glycation end products (AGEs), 8-hydroxy-2'-deoxyguanosine (8-OHdG), ferric reducing ability of plasma (FRAP), high-sensitivity C-reactive protein (hs-CRP), and nitric oxide (NO) were used as biomarkers. Results We found significantly elevated levels of MDA (2.1590±0.68221 µmol/L vs 0.8769±0.2958 µmol/L, p = <0.001), PCC (0.0905±0.040 nmol/L vs 0.0501±0.024 nmol/L, p = <0.001) and 8-OHdG (47.0757±37.09105 ng/mL vs 18.8450±9.31479 ng/mL, p = <0.001) in SAKI patients compared to controls, indicating increased oxidative damage to lipids, proteins, and DNA respectively. Although AGEs showed higher levels in SAKI patients, the difference was not significant. FRAP levels were significantly reduced [0.214 (0.051-0.489) mmol/L vs 0.470 (0.136-0.564) mmol/L, p = 0.024], indicating compromised antioxidant capacity. Significantly elevated levels of hs-CRP [40.18 (16.96-77.56) mg/L vs 1.44 (0.5-4.45) mg/L, p = <0.001] and NO [25.59 (22.75-28.43) µmol/L vs 14.218 (11.37-16.35) µmol/L, p = <0.001] confirmed the presence of inflammation and endothelial dysfunction in these patients. Conclusion Our study demonstrated oxidative stress, including oxidative DNA damage, inflammation, and endothelial dysfunction, in SAKI patients. Understanding these intricate mechanisms could lead to the development of novel diagnostic tools and therapeutic strategies.
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Affiliation(s)
| | - Aparna R. Bitla
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Siva Kumar Vishnubotla
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Ram Rapur
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
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Menon JC, Sreekrishnan TP, Nair SB, Pillay VV, Kanungo S, Aravind MS, Bharti OK, Joseph JK, Pati S. Snakebite envenoming in India: it is time we look beyond the concept of the Big Four species. Trans R Soc Trop Med Hyg 2025:traf042. [PMID: 40223652 DOI: 10.1093/trstmh/traf042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Revised: 02/04/2025] [Accepted: 03/28/2025] [Indexed: 04/15/2025] Open
Abstract
India faces substantial challenges from snakebite envenoming secondary to the high morbidity, mortality and financial burden, particularly in rural communities. While concentrated on the 'Big Four' venomous species, recent research indicates a necessity to expand the focus to encompass additional medically relevant species. This review emphasizes the geographic heterogeneity in venom among these snakes, which impacts antivenom effectiveness and necessitating region-specific formulations. This analysis highlights the shortcomings of current antivenoms and identifies non-Big Four species involved in snakebite envenoming, advocating for an urgent shift to inclusive antivenom strategies that integrate local venom profiles to enhance treatment effectiveness and thereby reduce snakebite-related morbidity and mortality. Improved training for healthcare providers and enhancements in anti-snake venom quality are essential for meeting the World Health Organization's 2030 Sustainable Development Goal objective of halving snakebite-related fatalities and disabilities. Incorporating snakebite management into national health programs and conducting epidemiological research systematically are crucial to mitigating this preventable health concern.
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Affiliation(s)
- Jaideep C Menon
- Adult Cardiology and Public Health, Amrita Institute of Medical Sciences, Kochi 682041, India
| | - T P Sreekrishnan
- Emergency Medicine, Amrita Institute of Medical Sciences, Kochi 682041, India
| | - Sabarish B Nair
- Emergency Medicine, Amrita Institute of Medical Sciences, Kochi 682041, India
| | - Vijay V Pillay
- Poison Control Centre, Professor, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi 682041, India
| | - Srikanta Kanungo
- ICMR-Regional Medical Research Centre, Bhubaneshwar 751023, India
| | - M S Aravind
- Department of Public Health, Amrita Institute of Medical Sciences, Kochi 682041, India
| | - Omesh K Bharti
- State Institute of Health and family Welfare, Himachal Pradesh, India
| | - Joseph K Joseph
- Department of Nephrology, Little Flower Hospital and Research Centre, Angamaly, Kochi 683572, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneshwar 751023, India
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Kumar R, Haripriya V, Patra A, Kalita B, Vanuopadath M, Nair BG, Mahato R, Lalremsanga HT, Khan MR, Bala A, Mukherjee AK. Proteomic and functional characterisation of Trimeresurus popeiorum (Pope's pit viper) venom proteins: Role of enzymatic and non-enzymatic venom toxins in envenomation pathophysiology. Int J Biol Macromol 2025; 304:140638. [PMID: 39914545 DOI: 10.1016/j.ijbiomac.2025.140638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 01/28/2025] [Accepted: 02/01/2025] [Indexed: 02/13/2025]
Abstract
Snakebite remains a significant public health issue in tropical regions, with 4.5 to 5.4 million incidents annually. Trimeresurus popeiorum (Pope's Pit Viper), found in Southeast Asia and northeast India, poses a potential threat, yet its venom's protein composition and toxicity are poorly understood. In this study, we used label-free quantitative proteomics to analyze the venom of T. popeiorum, identifying 106 proteins across 12 venom protein families. Notably, 60 % of the venom consisted of proteolytic enzymes, correlating with its prominent metalloprotease, fibrin(ogen)lytic, procoagulant, and thrombin-like activities. The proteome composition also correlates with the clinical effects such as consumption coagulopathy and local effects, seen in victims of Pit Viper envenomation in northeast India. Our findings suggest that T. popeiorum venom is less toxic than other Viperinae species such as Daboia russelii and Echis carinatus, likely due to isoform-level variations in certain toxin classes, including metalloprotease and serine protease. The venom's lethal dose (LD50) in Swiss albino mice was 1 mg/kg, and it caused haemorrhage, tissue necrosis, edema, myotoxicity, and defibrinogenation. Histopathological examination of the TPV-treated mice showed notable toxic effects, including marked hepatic vacuolation in the liver, damage to cardiac muscle and vascular congestion in the heart, bronchial epithelial hyperplasia with cellular infiltration in the interstitial and peribronchiolar regions of the lungs, as well as tubular necrosis and haemorrhage in the kidneys. This research provides the first comprehensive analysis of T. popeiorum venom, highlighting its pharmacological effects and the need for greater medical attention to this lesser-known species.
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Affiliation(s)
- Rahul Kumar
- Life Sciences Division, Institute of Advanced Study in Science and Technology (IASST), Vigyan Path, Paschim Boragaon, Guwahati 781035, Assam, India; Academy of Science and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - V Haripriya
- Amrita School of Nanosciences & Molecular Medicine, Amrita Vishwa Vidyapeetham, AIMS-, Kochi, Kerala 682041, India
| | - Aparup Patra
- Amrita Research Centre, Amrita Vishwa Vidyapeetham, Faridabad, Haryana 121002, India
| | - Bhargab Kalita
- Amrita School of Nanosciences & Molecular Medicine, Amrita Vishwa Vidyapeetham, AIMS-, Kochi, Kerala 682041, India; Amrita Research Centre, Amrita Vishwa Vidyapeetham, Faridabad, Haryana 121002, India
| | - Muralidharan Vanuopadath
- School of Biotechnology, Amrita Vishwa Vidyapeetham, Amritapuri, Clappana P.O, Kollam, Kerala 690525, India
| | - Bipin Gopalakrishnan Nair
- School of Biotechnology, Amrita Vishwa Vidyapeetham, Amritapuri, Clappana P.O, Kollam, Kerala 690525, India
| | - Rosy Mahato
- Life Sciences Division, Institute of Advanced Study in Science and Technology (IASST), Vigyan Path, Paschim Boragaon, Guwahati 781035, Assam, India; Academy of Science and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - H T Lalremsanga
- Developmental Biology and Herpetology Laboratory, Department of Zoology, Mizoram University, Aizawl 796004, Mizoram, India
| | - Mojibur R Khan
- Life Sciences Division, Institute of Advanced Study in Science and Technology (IASST), Vigyan Path, Paschim Boragaon, Guwahati 781035, Assam, India; Academy of Science and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Asis Bala
- Life Sciences Division, Institute of Advanced Study in Science and Technology (IASST), Vigyan Path, Paschim Boragaon, Guwahati 781035, Assam, India; Academy of Science and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Ashis K Mukherjee
- Life Sciences Division, Institute of Advanced Study in Science and Technology (IASST), Vigyan Path, Paschim Boragaon, Guwahati 781035, Assam, India; Academy of Science and Innovative Research (AcSIR), Ghaziabad 201002, India; Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur 784028, Assam, India.
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Sarangi N, Laxme RRS, Sunagar K. Significant Serpents: Predictive Modelling of Bioclimatic Venom Variation in Russell's Viper. PLoS Negl Trop Dis 2025; 19:e0012949. [PMID: 40208847 PMCID: PMC11984747 DOI: 10.1371/journal.pntd.0012949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 02/24/2025] [Indexed: 04/12/2025] Open
Abstract
BACKGROUND Russell's viper (Daboia russelii) is the clinically most important snake species in the world. Considerable variation has been documented in D. russelii venoms across the Indian subcontinent, which can drive the diverse envenomation profiles in snakebite victims. Therefore, understanding the role of ecological and environmental factors influencing the compositional and functional variation can provide critical insights into the complex evolutionary adaptations of this species and pave the way for the development of targeted therapies. METHODS We examined the influence of bioclimatic factors on D. russelii venom functions by analysing 115 samples sourced from various locations across India. The enzymatic activities of major toxins, such as proteases and phospholipases, were estimated to capture the functional variation in these venoms. Multiple regression models were developed to evaluate the relationship between venom variability and the historical climate data, specifically temperature and precipitation. Furthermore, predictive models were employed to map venom phenotypes across the distribution range of D. russelii. FINDINGS Our findings reveal a collective influence of various temperature and precipitation parameters that partly explain the variability in enzymatic activities of D. russelii venom. Our models effectively captured regional differences in venom composition and linked climatic conditions with functional variations. CONCLUSION This study highlights the significant role of abiotic factors in shaping the venom profiles of Russell's vipers across India. The predictive venom phenotype maps developed from our models can guide the deployment of targeted therapies and treatment protocols across the biogeographically diverse Indian subcontinent and improve clinical treatment outcomes of D. russelii envenoming. This research enhances our understanding of venom phenotype evolution and has practical implications for improving snakebite management.
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Affiliation(s)
- Navaneel Sarangi
- Centre for Ecological Sciences, Indian Institute of Science Bangalore, India
| | - R. R. Senji Laxme
- Centre for Ecological Sciences, Indian Institute of Science Bangalore, India
| | - Kartik Sunagar
- Centre for Ecological Sciences, Indian Institute of Science Bangalore, India
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Menon JC, Nair SB, Sreekrishnan TP, Pillay VV, Kanungo S, Pati S. Case for a one-health approach to venomous snakebite, using the epidemiological triad model, for mitigation. ONE HEALTH OUTLOOK 2025; 7:11. [PMID: 40087796 PMCID: PMC11909857 DOI: 10.1186/s42522-024-00128-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 12/06/2024] [Indexed: 03/17/2025]
Abstract
BACKGROUND Snakebite envenoming (SBE) was listed as a Neglected Tropical Disease (NTD), by the WHO in 2017. SBE kills more victims than all the other NTDs put together. SBE is a condition associated with poverty, inequity, inaccessibility and poor health systems. The major burden of SBE is borne by the countries of South-Asia, led by India, with an estimated 58,000 deaths annually. This as compared with the USA or Australia where deaths due to SBE is in a single digit, despite having equally venomous species. SBE is also a significant cause for loss of livestock in the Tropics. Research in the domain of snakebite has largely been limited to study of venoms and therapeutic aspects, and not as much on snake behaviour and habitats, and the environment. BODY: Snakebite is most often accidental, preventable and treatable. For mitigation of snakebite and the complications thereof, snakebite and SBE need be viewed from a one-health framework. The one-health approach to snakebite factors for the role of the environment, habitats, study of snakes, venom, factors and circumstances contributing to the accident. The current one-health framework proposed using the 'epidemiologic triad' model of agent-host-environment, allows for a better understanding and descriptione of the snake-human/livestock conflict. With snakes being the agent, humans/ livestock the host, and the ecosystem harbouring snakes the environment. This approach helps us to delineate the individual attributes influencing the snake-human conflict, and its outcomes. In the proposed one-health model we expand on the agent-host-environment (proximal factors), to an outer setting of more distal factors which too have an influence on snakebite and SBE. The outer setting includes the social determinants of health, eco climatic factors, socio-cultural factors, health systems, infrastructure and development all of which either directly or indirectly have a bearing on snakebite, and the outcomes resulting from the accident. (Fig. 1). CONCLUSION The one-health model built on the epidemiologic triad model helps encompass most of the factors that influence or lead to the snake-human/ livestock conflict. This model will facilitate preventative measures and help address the steps required to mitigate death and morbidity due to SBE.
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Affiliation(s)
- Jaideep C Menon
- Adult Cardiology & Public health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682041, India.
| | - Sabarish B Nair
- Emergency Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682041, India
| | - T P Sreekrishnan
- Emergency Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682041, India
| | - Vijay V Pillay
- Poison Control Centre, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682041, India
| | - Srikanta Kanungo
- ICMR- Regional Medical Research Centre, Bhubaneshwar, 751 023, India
| | - Sanghamitra Pati
- ICMR- Regional Medical Research Centre, Bhubaneshwar, 751 023, India
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Kumar A, Banjara RA, Aneshwari RK, Khan J, Bernarde PS. A comprehensive review on recent advances in the use of ethnomedicinal plants and their metabolites in snake bite treatment. Front Pharmacol 2025; 16:1548929. [PMID: 40196363 PMCID: PMC11973492 DOI: 10.3389/fphar.2025.1548929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Accepted: 02/12/2025] [Indexed: 04/09/2025] Open
Abstract
Snakebites are a severe medical and social issue, particularly in tropical and subtropical countries with minimal medical facilities, where the most dangerous snakes are found. Worldwide, most rural areas use medicinal plants alone or in combination as antidotes for snakebite treatment. Local knowledge of medicinal plants for snakebite treatment plays a more critical role in primary healthcare services in rural areas. As a result of this review, it is revealed that 39% of herbs, 38% of shrubs, 18% of trees, 2% of climbers, 2% of bulbs, and 1% of ferns have snake antivenom potential, which is indicative of the presence of numerous phytochemicals such as alkaloids, coumarins, curcuminoids, flavonoids, steroids, triterpenoids, and cinnamic acid in particular plants. According to the availability of information, the data focus on the plants, their families, and their parts from various literature sources. In the future, the valuable plants reported here and their phytoconstituents may be potential sources for developing effective natural drugs for snake bite treatments. Therefore, this review is a comprehensive study of the snake antivenom potential of various medicinal plants and their bioactive compounds.
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Affiliation(s)
- Ashish Kumar
- Department of Biotechnology, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur, Chhattisgarh, India
| | - Rameshwari A. Banjara
- Department of Chemistry, Rajeev Gandhi Government Postgraduate College, Ambikapur, Chhattisgarh, India
| | | | - Junaid Khan
- Department of Pharmacy, Sant Gahira Guru Vishwavidyalaya, Sarguja Ambikapur, Chhattisgarh, India
| | - Paulo Sergio Bernarde
- Laboratório de Herpetologia, Centro Multidisciplinar, Campus Floresta, Universidade Federal do Acre, Cruzeiro do Sul, Acre, Brazil
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Sasidharan P, Kaeley N, Mahala P, Jose JR, Shankar T, Santhalingan S, Sharma A, Kumar B, Kumar MA, Dhar M. Clinical and demographic profiling of snakebite envenomation in a tertiary care centre in northern India. Int J Emerg Med 2025; 18:50. [PMID: 40065251 PMCID: PMC11892126 DOI: 10.1186/s12245-024-00796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Accepted: 12/20/2024] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Snake bites are a major cause of emergency visits in tropical countries like India, with actual mortality and morbidity likely higher due to underreporting. The aim of the study was to analyze the clinical and demographic profiles of snake bites at the Department of Emergency Medicine, AIIMS Rishikesh, over two years (July 2021 to July 2023). METHODS Patients aged over 18 with witnessed or suspected snake bites were included. Data on demographics, clinical history, laboratory parameters, treatment, and outcomes were collected. RESULTS Most patients were male (68.3%) and aged 31-50 years (35.6%). Farmers made up 57.4% of the cohort. Bites occurred mostly in the evening (46.5%) and during the monsoon (71.3%). Symptoms varied: 48.5% were asymptomatic, 31.7% had hemotoxic symptoms, and 15.8% experienced neurotoxic symptoms, including ptosis. Hemotoxic bites frequently involved bleeding at the bite site (93.8%) and gum bleeding (46.9%). Local complications were noted in 7.9% of cases. Neuroparalytic bites required ventilatory support in 62.5%. Blood products were administered to 31% of patients with hemotoxic bites, hemodialysis to 19%, and plasmapheresis and hyperbaric oxygen therapy to 6.3%. Out of the 69 symptomatic patients (68.3%) who received anti-snake venom (ASV), 28 (40.6%) patients developed adverse reactions. CONCLUSION This study provides a detailed analysis of suspected snakebites in Uttarakhand and surrounding areas, highlighting the importance of early recognition, prompt treatment, and timely referral to prevent fatalities. The administration of anti-snake venom (ASV) is identified as the most critical intervention, though lack of awareness in rural areas complicates management. The study calls for targeted public health campaigns to educate communities about early snakebite recognition and the role of ASV. It also stresses the need for region-specific protocols and improved healthcare access, emphasizing the importance of referral systems for advanced interventions like hemodialysis and intubation. Overall, the study advocates for enhanced public awareness and healthcare infrastructure to reduce snakebite incidence and mortality in rural populations.
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Affiliation(s)
| | - Nidhi Kaeley
- All India Institute of Medical Sciences, Rishikesh, India.
| | - Prakash Mahala
- All India Institute of Medical Sciences, Rishikesh, India
| | | | | | | | - Ankit Sharma
- All India Institute of Medical Sciences, Rishikesh, India
| | - Balwant Kumar
- All India Institute of Medical Sciences, Rishikesh, India
| | | | - Minakshi Dhar
- All India Institute of Medical Sciences, Rishikesh, India
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10
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Ralph R, Ramesh RM, Jambugulam M, Deborah AA, Aruldas K, Moorthy NA, John SM, Walson JL, Zachariah A, Ajjampur SSR. Health-seeking behaviours and traditional healer practices for snakebite in rural and tribal communities in southern India. Trans R Soc Trop Med Hyg 2025; 119:317-326. [PMID: 39749525 DOI: 10.1093/trstmh/trae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/03/2024] [Accepted: 10/17/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Nearly 60 000 Indians die of snakebite envenoming each year. Most deaths occur in rural communities and remote tribal settlements. We describe snakebite-related epidemiology and health-seeking behaviours in a rural (Timiri) and remote tribal block (Jawadhu Hills) in Tamil Nadu, India. METHODS This cross-sectional survey used structured questionnaires for information pertaining to snakebites and their treatment in the preceding year. Treatment-seeking behaviour from the moment reported until recovery was mapped. Traditional healers residing in the two blocks were also surveyed. RESULTS Snakebite incidence and mortality were 174/100 000 population and 2.7/100 000 population in Jawadhu Hills and 194/100 000 population and 2.6/100 000 population in Timiri, respectively. More snakebite victims applied tourniquets in Jawadhu Hills (90%) than in Timiri (69%). Traditional healers were the first contact for 64% in Jawadhu Hills. Ambulances and buses were reported as unavailable in Jawadhu Hills. Traditional healers in Jawadhu Hills did not refer snakebite victims to hospitals. CONCLUSIONS Three challenges to snakebite mitigation in Indian rural and tribal communities highlighted in this study are potentially harmful first aid, a disconnect between traditional healers and the public health system and a lack of emergency transport to health facilities. Addressing these challenges would necessitate community awareness, traditional healer engagement and improved means of public transportation.
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Affiliation(s)
- Ravikar Ralph
- Poison Control Center, Department of Medicine Unit-1, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Rohan Michael Ramesh
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Mohan Jambugulam
- Poison Control Center, Department of Medicine Unit-1, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Arpitha Anbu Deborah
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | | | - Sushil Mathew John
- Low Cost Effective Care Unit, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Judd L Walson
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore 21205, USA
| | - Anand Zachariah
- Poison Control Center, Department of Medicine Unit-1, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Sitara Swarna Rao Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, Tamil Nadu, India
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11
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Hussain SS, Kingsley JD. Metabolomics and proteomics: synergistic tools for understanding snake venom inhibition. Arch Toxicol 2025; 99:915-934. [PMID: 39760869 DOI: 10.1007/s00204-024-03947-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 12/17/2024] [Indexed: 01/07/2025]
Abstract
Snake envenomation presents a significant global health challenge, especially in rural areas of tropical and subtropical regions. Traditional antivenom therapies face limitations related to efficacy, availability, and specificity, prompting a need for novel approaches. Recent advancements in omics technologies, particularly metabolomics and proteomics, have enhanced our understanding of snake venom composition, toxicity, and potential therapeutic strategies. Metabolomics allows for the study of metabolic changes induced by venom, providing insights into disrupted pathways and possible inhibitors. Proteomics facilitates the identification and characterization of venom proteins, unveiling their interactions with therapeutic agents. Integrative databases such as the Snake Venom Database (SVDB) and STAB Profiles enhance this research by cataloging venom components and aiding in the analysis of venom-antivenom interactions. The combined application of metabolomics and proteomics has led to the identification of crucial metabolic pathways and protein targets essential for effective venom inhibition. This review explores current advances in these fields, emphasizing the role of omics in identifying novel inhibitors and developing next-generation antivenoms. The integrated approach of metabolomics and proteomics offers a comprehensive understanding of snake venom biology, paving the way for more effective and tailored therapeutic solutions for envenomation.
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Affiliation(s)
- Sana S Hussain
- Department of Integrative Biology, School of Bioscience and Technology, Vellore Institute of Technology (VIT), Vellore, 632014, Tamil Nadu, India
| | - J Danie Kingsley
- Department of Integrative Biology, School of Bioscience and Technology, Vellore Institute of Technology (VIT), Vellore, 632014, Tamil Nadu, India.
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Ahuja NJ, Pasi N, Naz H, Chamola R. Smart IoT-based snake trapping device for automated snake capture and identification. ENVIRONMENTAL MONITORING AND ASSESSMENT 2025; 197:258. [PMID: 39928180 DOI: 10.1007/s10661-025-13722-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 01/29/2025] [Indexed: 02/11/2025]
Abstract
The threat of snakebites to public health, particularly in tropical and subtropical regions, requires effective mitigation strategies to avoid human-snake interactions. With the development of an IoT-based smart snake-trapping device, an innovative non-invasive solution for preventing snakebites is presented, autonomously capturing and identifying snakes. Using artificial intelligence (AI) and Internet of Things (IoT) technologies, the entire system is designed to improve the safety and efficiency of snake capture, both in rural and urban areas. A camera and sensors are installed in the device to detect heat and vibration signatures, mimicking the natural prey of snakes using tungsten wire and vibration motors to attract them into the trap. A real-time classification algorithm based on deep learning determines whether a snake is venomous or non-venomous as soon as the device detects it. This algorithm utilizes a transfer learning approach using a convolutional neural network (CNN) and has been trained using snake images, achieving an accuracy of 91.3%. As a result of this identification process, appropriate actions are taken, such as alerting authorities or releasing non-venomous snakes into the environment in a safe manner. Through the integration of IoT technology, users can receive real-time notifications and data regarding the trap via a smartphone application. The system's connectivity allows for timely intervention in case of venomous species, reducing snakebite risks. Additionally, the system provides information regarding snake movement patterns and species distribution, contributing to the study of broader ecological issues. An automated and efficient method of managing snakes could be implemented in snakebite-prone regions with the smart trapping device.
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Affiliation(s)
- Neelu Jyothi Ahuja
- Department of Computer Science, University of Petroleum and Energy Studies, Dehradun, India.
| | - Nitin Pasi
- Department of Computer Science, University of Petroleum and Energy Studies, Dehradun, India
| | - Huma Naz
- Department of Computer Science, University of Petroleum and Energy Studies, Dehradun, India
| | - Rahul Chamola
- Department of Mechanical Engineering, School of Advanced Engineering, University of Petroleum and Energy Studies, Dehradun, India
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13
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Pandey DP, Adhikari B, Pandey P, Sapkota K, Bhusal MK, Kandel P, Shrestha DL, Shrestha BR. Cost of Snakebite and Its Impact on Household Economy in Southern Nepal. Am J Trop Med Hyg 2025; 112:431-440. [PMID: 39561391 PMCID: PMC11803655 DOI: 10.4269/ajtmh.24-0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 09/29/2024] [Indexed: 11/21/2024] Open
Abstract
We aimed to estimate the cost of snakebite and its impact on the economy of snakebite-affected households in southern Nepal. We conducted cross-sectional and prospective studies of confirmed snakebite cases at two hospitals in south central and southwestern Nepal during May to October 2020. We estimated the economic impact of snakebite on affected households by evaluating direct and indirect costs for treatments and opportunity costs of patients and attendants (household members or relatives). We included 553 snakebites that caused 185 envenomings (34%), resulting in 15 deaths (case fatality rate, 8%). These occurred across 87 subdistricts, 21 districts, and six provinces (25% rural, 75% urban overall). Median direct, indirect, and opportunity costs of snakebite were US$95.30, US$65.80, and US$4,995.20 for envenomings and US$14.50, US$13.50, and US$10.10 for nonenvenomed snakebites, respectively. The impact of snakebite envenomings on household economy included not only the remarkable out-of-pocket expenditure but also the loss of patients' and visitors' productivity (i.e., daily income/wages while seeking snakebite care in hospitals). Lack of insurance for snakebite treatment increased the psychosocial and economic burden. Deterioration in family economy and psychology was particularly severe when death from snakebite affected breadwinners. Therefore, taking action to minimize the impact of snakebite envenoming becomes a priority for all.
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Affiliation(s)
- Deb Prasad Pandey
- Department of Veterinary Microbiology and Parasitology, Agriculture and Forestry University, Bharatpur Metropolitan City, Nepal
- Institute for Social and Environmental Research–Nepal, Bharatpur Metropolitan City, Nepal
| | - Bhojraj Adhikari
- Department of Medicine, Bharatpur Hospital, Bharatpur Metropolitan City, Nepal
| | - Parash Pandey
- Department of Anesthesiology, Bheri Hospital, Nepalgunj, Nepal
| | - Kalyan Sapkota
- Department of Medicine, Bharatpur Hospital, Bharatpur Metropolitan City, Nepal
| | - Mina Kumari Bhusal
- Bharatpur Hospital Nursing College, Bharatpur Hospital, Bharatpur Metropolitan City, Nepal
| | - Priti Kandel
- Department of Microbiology, Birendra Multiple Campus, Bharatpur Metropolitan City, Nepal
| | | | - Bhola Ram Shrestha
- Department of General Practice and Emergency Medicine, Chitwan Medical College, Bharatpur Metropolitan City, Nepal
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14
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Daga MK, Kumar N, Singh H. Biomarkers in Snakebite: Will This be a Reality in Near Future? Indian J Crit Care Med 2025; 29:104-105. [PMID: 40110141 PMCID: PMC11915434 DOI: 10.5005/jp-journals-10071-24917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2025] Open
Abstract
How to cite this article: Daga MK, Kumar N, Singh H. Biomarkers in Snakebite: Will This be a Reality in Near Future? Indian J Crit Care Med 2025;29(2):104-105.
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Affiliation(s)
- Mradul Kumar Daga
- Department of Internal Medicine and Infectious Diseases, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Naresh Kumar
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Harpreet Singh
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
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Sreekumar A, Abraham SV, Rajeev PC, Chanchal A B V, Suseel A, Mathew D, George CR, Palatty BU. Educating healthcare workers in snakebite management: A study to determine the effectiveness of the snake bite life support workshop. Toxicon 2025; 255:108235. [PMID: 39793626 DOI: 10.1016/j.toxicon.2025.108235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 01/06/2025] [Accepted: 01/07/2025] [Indexed: 01/13/2025]
Abstract
INTRODUCTION Snakebite envenomation is a significant global health issue, with India bearing a substantial burden. Despite the development of guidelines, knowledge gaps and lack of training persist among healthcare workers (HCWs), contributing to high morbidity and mortality. This study aimed to evaluate the impact of the Snake Bite Life Support (SBLS) workshop on HCWs' knowledge, practices, self-efficacy, and advocacy skills in snakebite management. METHODS A pre-post interventional study was conducted during the SBLS workshop at a tertiary care center in May 2024. HCWs' knowledge, practical skills, self-efficacy, and advocacy skills were assessed using standardized questionnaires and a modified General Self-Efficacy (GSE) scale, both before and after the workshop. Data were analyzed using SPSS v25.0, employing paired t-tests and Wilcoxon signed-rank tests for comparison. RESULTS Forty-one HCWs completed the pre- and post-workshop assessments. Significant improvements were observed in knowledge, particularly in avoiding false positive 20-min whole blood clotting test (20WBCT) results (p = 0.020) and premedication for antivenom (p < 0.001). Participants reported a marked increase in self-efficacy across all GSE parameters and demonstrated enhanced advocacy intent in resource management, policy influence, and educational outreach. The workshop influenced practice changes, notably reducing the administration of antivenom in confirmed hump-nosed pit viper bites. CONCLUSION The SBLS workshop effectively enhanced HCWs' knowledge, management practices, self-efficacy, and advocacy intentions, emphasizing the need for integrating such training into healthcare education to drive systemic change in snakebite management and improve patient outcomes. Future studies should focus on long-term impacts and broader implementation.
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Affiliation(s)
- Aravind Sreekumar
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Siju V Abraham
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India.
| | - P C Rajeev
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Vijay Chanchal A B
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Appu Suseel
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Deo Mathew
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Collin R George
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Babu U Palatty
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
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Gololo AA, Veettil SK, Anantachoti P, Taychakhoonavudh S, Patikorn C. Epidemiological models to estimate the burden of snakebite envenoming: A systematic review. Trop Med Int Health 2025; 30:71-83. [PMID: 39743841 DOI: 10.1111/tmi.14080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
BACKGROUND Epidemiological modelling studies in snakebite envenoming research are evolving. Their techniques can be essential in filling the knowledge gap needed to attain the World Health Organization's (WHO) goal of halving the burden of snakebite envenoming by complementing the current data scarcity. Hence, there is a need for a systematic review to summarise epidemiological models used in estimating the burden of snakebite envenoming. METHODS We conducted a systematic review by searching PubMed, EMBASE, and Scopus to identify articles reporting epidemiological models in snakebite envenoming from database inception to 31st December 2023. A narrative synthesis was performed to summarise types of models, methodologies, input parameters, model outputs, and associating factors. RESULTS Thirty-nine modelling studies were included from 2426 retrieved articles, comprising statistical models (76.9%) and mathematical models (23.1%). Most of the studies were conducted in South Asia, (35.9%) and Latin America (35.9%), and only a few (5.1%) were a global burden estimation. The eligible studies constructed 42 epidemiological models, of which 33 were statistical models that included regression, (60.6%) geostatistical (21.2%), and time series, (18.2%) while 9 mathematical models comprised compartmental, (44.4%) agent-based, (22.2%) transmission dynamics, (11.1%) network, (11.1%) and a simple mathematical model (11.1%). The outputs of the models varied across the study objectives. Statistical models analysed the relationship between incidence, (83.3%) mortality, (33.3%) morbidity (16.7%) and prevalence (10.0%) and their associating factors (environmental, [80%] socio-demographic [33.3%] and therapeutic [10.0%]). Mathematical models estimated incidence, (100%) mortality (33.3%), and morbidity (22.2%). Five mathematical modelling studies considered associating factors, including environmental (60%) and socio-demographic factors (40%). CONCLUSION Mathematical and statistical models are crucial for estimating the burden of snakebite envenoming, offering insights into risk prediction and resource allocation. Current challenges include low-quality data and methodological heterogeneity. Modelling studies are needed, and their continued improvement is vital for meeting WHO goals. Future research should emphasise standardised methodologies, high-quality community data, and stakeholder engagement to create accurate, applicable models for prevention and resource optimization in high-burden regions, including Africa and Asia.
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Affiliation(s)
- Ahmed Adamu Gololo
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Sajesh K Veettil
- Department of Pharmacy Practice, School of Pharmacy, IMU University, Kuala Lumpur, Malaysia
| | - Puree Anantachoti
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Suthira Taychakhoonavudh
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Chanthawat Patikorn
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
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17
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Collinson S, Lamb T, Cardoso IA, Diggle PJ, Lalloo DG. A systematic review of variables associated with snakebite risk in spatial and temporal analyses. Trans R Soc Trop Med Hyg 2025:trae131. [PMID: 39817354 DOI: 10.1093/trstmh/trae131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/31/2024] [Accepted: 11/28/2024] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND Snakebite is a priority neglected tropical disease, but incidence data are lacking; current estimates rely upon incomplete health facility reports or ad hoc surveys. Spatial analysis methods harness statistical associations between case incidence and spatially varying factors to improve estimates. This systematic review aimed to identify variables associated with snakebite risk in spatial and temporal analyses for inclusion in geospatial studies to improve risk estimation accuracy. METHODS We searched MEDLINE, Global Health, PubMed and Web of Science in January 2023 for studies published since 1980 assessing snakebite outcomes and spatially varying factors at the setting level. Study quality was assessed using an adapted Joanna Briggs Institute tool. The results are presented by narrative synthesis. RESULTS Thirty-five studies were eligible; the majority were from Central and South America (18), then Asia (11). Climate and environment were most frequently assessed, with temperature, humidity and tree cover predominantly positively associated with snakebite risk, drought negatively associated and altitude negative/mixed. Crop and livestock variables mostly showed positive associations; population density and urban residence overwhelmingly displayed negative associations. CONCLUSIONS This review identifies key variables that should be considered in future snakebite risk research. Limitations include low research availability from the highest risk regions. There is an evident need for greater research into snakebite risk variation, particularly in sub-Saharan Africa.
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Affiliation(s)
- Shelui Collinson
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Thomas Lamb
- Department of Infectious diseases and Tropical Medicine, Manchester Foundation Trust, Manchester, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao Peoples Democratic Republic
| | - Iara A Cardoso
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Peter J Diggle
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- CHICAS, Lancaster University Medical School, Bailrigg, Lancaster LA1 4YF, UK
| | - David G Lalloo
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Gopalakrishnan M, Kumar Ph A, Tanwar D, Bhat Ks S, Choudhary B, Garg MK. Antivenom ineffectiveness in Echis carinatus sochureki envenoming: a five-year, single-centre experience from India. Trans R Soc Trop Med Hyg 2025:trae111. [PMID: 39749523 DOI: 10.1093/trstmh/trae111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 09/10/2024] [Accepted: 10/24/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Snakebite is a neglected tropical disease that causes significant morbidity and mortality in India. In this study, we describe the clinical characteristics and outcomes of Echis carinatus sochureki envenoming from Western Rajasthan. We document the clinical ineffectiveness of the currently available Indian polyvalent antivenom in managing E. c. sochureki envenoming. METHODS In this ambispective study, conducted from 14 April 2019 to 15 April 2024, we enrolled all patients presenting to our emergency department at a tertiary care centre in Jodhpur, Rajasthan, with a history of snakebite. After they provided informed consent, the demographic details, bite geo-location, bite-to-antivenom time, antivenom dose, coagulation profile, mortality and duration of hospital stay of those patients with E. c. sochureki envenoming were recorded. RESULTS Of 210 patients screened, 105 had E. c. sochureki envenoming, 103 venom-induced consumption coagulopathy, 36 (34.3%) local bleeding and 55 (52.3%) systemic bleeding. The median bite-to-antivenom time was 2 (IQR: 1.13-4.0) h. The median antivenom dose was 22 (IQR: 10-30) vials. Of 92 patients who received antivenom, 63 (68.4%) were unresponsive. Total antivenom dose and geographical location (West zone) were significant predictors of antivenom unresponsiveness. Fifty-three of 70 patients (75.7%) had delayed hypofibrinogenaemia. The mean hospital stay was 8.3±7.1 d with nine (8.6%) mortalities. CONCLUSIONS Our study highlights the alarming finding of poor antivenom response to E. c. sochureki envenoming, with significant clinical bleeding and delayed coagulopathy. There is an urgent need for region-specific antivenom in Western India.
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Affiliation(s)
- Maya Gopalakrishnan
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Akhilesh Kumar Ph
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur 342005, India
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
| | - Divya Tanwar
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Samarth Bhat Ks
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Bharat Choudhary
- Department of Trauma and Emergency Medicine (Paediatrics), All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Mahendra K Garg
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur 342005, India
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Kuttalam S, Owens JB, Santra V, Ahmed MT, Das B, Das S, Koley A, Koley R, Barlow A, Malhotra A. Utilising snake rescue data to understand snake-human conflict in Hooghly, West Bengal, India. Trans R Soc Trop Med Hyg 2025:trae124. [PMID: 39749471 DOI: 10.1093/trstmh/trae124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 09/05/2024] [Accepted: 11/22/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Snakebite envenoming, classified as a neglected tropical disease, poses a significant threat to life in India, where it is estimated to cause 58 000 fatalities as well as 140 000 morbidities annually. To reduce the occurrence of snakebite, we need a comprehensive understanding of human-snake conflict ecology. Snake rescue networks represent a vital resource for gathering such ecological data. METHODS In this study, we utilised snake rescue data from 520 rescue encounters carried out by a local rescue network in Hooghly, West Bengal, from July 2020 to October 2022, to investigate patterns of human-snake conflict and the influence of climatic factors on these patterns. RESULTS The spectacled cobra Naja naja was the most encountered of the five venomous species involved in 365 rescues. Our analysis revealed a significant correlation between rescue location and venomous/non-venomous encounters, with non-venomous encounters being more prevalent inside built-up locations. Rainfall on the previous day significantly increased encounters and influenced the species involved, while daily minimum temperature also influenced encounters with venomous species. We also found that both Bungarus (krait) species present were mostly encountered between 18:00 h and midnight. CONCLUSIONS This study highlights the multifaceted factors influencing human-snake conflicts in the region, including seasonality, geographic location, rainfall patterns, and temperature dynamics. It underscores the potential of snake rescue data as a valuable resource for deepening our understanding of regional variations in snake-human interactions.
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Affiliation(s)
- Sourish Kuttalam
- Molecular Ecology and Evolution at Bangor (MEEB), School of Environmental and Natural Sciences, Bangor University, Environment Centre Wales, Bangor LL57 2UW, UK
- Captive & Field Herpetology Ltd, 13 Hirfron, Llaingoch, Holyhead, Anglesey LL65 1YU, UK
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal 712407, India
| | - John Benjamin Owens
- Molecular Ecology and Evolution at Bangor (MEEB), School of Environmental and Natural Sciences, Bangor University, Environment Centre Wales, Bangor LL57 2UW, UK
- Captive & Field Herpetology Ltd, 13 Hirfron, Llaingoch, Holyhead, Anglesey LL65 1YU, UK
| | - Vishal Santra
- Captive & Field Herpetology Ltd, 13 Hirfron, Llaingoch, Holyhead, Anglesey LL65 1YU, UK
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal 712407, India
| | - Molla T Ahmed
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal 712407, India
| | - Biswajit Das
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal 712407, India
| | - Surojit Das
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal 712407, India
| | - Ayan Koley
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal 712407, India
| | - Rakesh Koley
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal 712407, India
| | - Axel Barlow
- Molecular Ecology and Evolution at Bangor (MEEB), School of Environmental and Natural Sciences, Bangor University, Environment Centre Wales, Bangor LL57 2UW, UK
| | - Anita Malhotra
- Molecular Ecology and Evolution at Bangor (MEEB), School of Environmental and Natural Sciences, Bangor University, Environment Centre Wales, Bangor LL57 2UW, UK
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20
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Kuttalam S, Malhotra A. Challenges of researching snakes in India. Trans R Soc Trop Med Hyg 2025:trae104. [PMID: 39749478 DOI: 10.1093/trstmh/trae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 09/14/2024] [Accepted: 10/23/2024] [Indexed: 01/04/2025] Open
Abstract
The ambitious WHO goal of halving snakebite mortality by 2030 is challenged by a number of logistical hurdles, none more so than in India where snakebite envenomation presents a multifaceted challenge. We have collaborated with several organizations focused on snakebite in India over the last 11 years, with an emphasis on fieldwork to collect samples from venomous snakes in various regions, particularly understudied regions in the northeast and western Himalayas. This programme has encountered several significant obstacles, including securing permits from government organizations to collect snake samples in the field, obtaining long-term research funding, coordinating multidisciplinary collaboration on snakebite projects and engaging with grassroots stakeholders who are most affected by snakebite incidents. We emphasize the necessity of adopting a nationally coordinated yet regionally diversified approach that accounts for the biogeographical and cultural complexity of the country.
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Affiliation(s)
- Sourish Kuttalam
- Molecular Ecology and Evolution at Bangor (MEEB), School of Environmental and Natural Sciences, Bangor University, Environment Centre Wales, Bangor LL57 2UW, UK
- Captive & Field Herpetology Ltd, 13 Hirfron, Llaingoch, Holyhead, Anglesey LL65 1YU, UK
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal 712407, India
| | - Anita Malhotra
- Molecular Ecology and Evolution at Bangor (MEEB), School of Environmental and Natural Sciences, Bangor University, Environment Centre Wales, Bangor LL57 2UW, UK
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21
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Naik H, Alexander GJ. The incidence of snakebite in South Africa and the challenges associated with lack of reporting. Trans R Soc Trop Med Hyg 2025:trae109. [PMID: 39749489 DOI: 10.1093/trstmh/trae109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/18/2024] [Accepted: 10/23/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Snakebite is a public health challenge that has a substantial impact on humans and snakes. Annually, millions of people are affected by snakebite globally but there is a paucity of detailed data on snakebite incidences. The aim of this study was to assess the patterns of snakebite incidences in South Africa. METHODS We collected data from hospital records, information from the National Snakebite Database and records from the AfriTox Telelog database from 2011 to 2024. RESULTS The combined dataset showed that 3496 snakebite incidences have been recorded over 12.5 years. The prevalence was calculated to be 5.63 per 100 000 individuals of the population for South Africa, with the highest prevalence in KwaZulu-Natal (8.89). Males made up 65.9% of snakebite incidences and most incidences were recorded between November and March. The snake species responsible for most snakebite incidences was Bitis arietans. CONCLUSION Snakebite is generally well managed in South Africa with few recorded deaths despite the relatively high number of bites. However, incidents are often not recorded or have missing information particularly regarding the circumstances of the bite. Our study provides insight on the snake species responsible for snakebite incidences in South Africa and can be used to create prevention measures.
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Affiliation(s)
- Hiral Naik
- School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Save the Snakes, R527, Blyderus, Hoedspruit 1380, South Africa
| | - Graham J Alexander
- School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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22
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Patra A, Mahapatra AD, Malhotra A, Santra V, Ghorai SK, Annadurai D. Conflict between sea snakes and humans on the coast of West Bengal and Odisha, India: perception, attitudes and incidents. Trans R Soc Trop Med Hyg 2025:trae086. [PMID: 39749493 DOI: 10.1093/trstmh/trae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/08/2024] [Accepted: 09/30/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Snakebite envenoming is a critical medical emergency and significant global public health issue, with India experiencing the highest annual snakebite deaths. Sea snakes in the Indian Ocean pose a severe threat to rural fishermen due to their potent neurotoxins. METHODS From December 2020 to December 2021, we conducted surveys at 15 fishing ports in East Medinipur, West Bengal, and Balasore, Odisha, India (between 21.805651 N 87.874188 E and 21.574851 N 87.374059 E). We interviewed 2301 fishermen in 421 group sessions to document sea snake bite incidents, outcomes and perceptions from 2012 onwards. Historical data were also retrieved from various databases and social media platforms. RESULTS We recorded 166 sea snake bite cases, with 55.4% fatalities, 2.4% permanent disabilities and 41% survivors. Gill net fishermen were the most affected, with most bites occurring while handling snakes caught in nets, particularly at dawn and dusk. Fishermen reported a significant decline in sea snake populations over the past decade due to by-catch and killing practices. CONCLUSIONS Sea snake bites are a major occupational hazard for Indian fishermen, with high fatality rates due to limited medical access. Increased awareness, safer handling practices and improved medical infrastructure are essential to reduce mortality and conserve sea snake populations. This study highlights the need for targeted interventions in affected communities.
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Affiliation(s)
- Anweshan Patra
- Centre of Advanced Study in Marine Biology, Annamalai University, Parangipettai 608502, India
| | - Ardhendu Das Mahapatra
- Reptilia Section, Zoological Survey of India, Indian Museum Campus, Kolkata, West Bengal 700016, India
| | - Anita Malhotra
- School of Environmental and Natural Sciences, Bangor University, Gwynedd LL57 2UW, UK
| | - Vishal Santra
- Society for Nature Conservation, Research and Community Engagement, Nalikul, Hooghly, West Bengal 712407, India
- Captive and Field Herpetology, 13 Hirfron, Anglesey LL65 1YU, UK
| | | | - D Annadurai
- Centre of Advanced Study in Marine Biology, Annamalai University, Parangipettai 608502, India
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23
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Prakash S, Vikram A, Kashif A, Khare S. Sochureki, the different saw- scaled viper: Challenges are many! Med J Armed Forces India 2025; 81:99-104. [PMID: 39872174 PMCID: PMC11762962 DOI: 10.1016/j.mjafi.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/19/2023] [Indexed: 01/29/2025] Open
Abstract
Snake bite is a major cause of mortality in the Indian subcontinent. The condition is fraught with the problem of under reporting. Most bites in India are caused by the "Big 4 species," based on this, the anti-snake venom (ASV) is also sourced from these species only. It has been observed that the venom of snakes from different regions respond differently to it, as is sourced mainly from snakes of southern region of India. We present a case of a saw-scaled viper (SSV) bite, where the patient had unusual presentation of thrombotic microangiopathy (TMA) along with venom-induced consumption coagulopathy (VICC). The patient was resistant to ASV and finally succumbed. The snake was identified as Echis carinatus sochureki (a subspecies of SSV). This case highlights that VICC is the commonest presentation in a SSV bite, rather than disseminated intravascular coagulation (DIC). The organ failure in such bites is due to rare coexistence of TMA (especially in an E carinatus sochureki bite) and should not be attributed to DIC. It also identifies that the polyvalent ASV produced in India is not effective against E carinatus sochureki bite.
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Affiliation(s)
- Sudeep Prakash
- Senior Advisor (Medicine) & Nephrology, Command Hospital (Southern Command), Pune, India
| | - Asturkar Vikram
- Neurologist & Physician, Command Hospital (Southern Command), Pune, India
| | - A.W. Kashif
- Professor, Department of Pathology, Armed Forces Medical College, Pune, India
| | - Soumitra Khare
- Resident, Department of Internal Medicine, Armed Forces Medical College, Pune, India
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24
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Chanda A, Salvi NC, Shelke PV, Kalita B, Patra A, Puzari U, Khadilkar MV, Mukherjee AK. Supplementation of polyclonal antibodies, developed against epitope-string toxin-specific peptide immunogens, to commercial polyvalent antivenom, shows improved neutralization of Indian Big Four and Naja kaouthia snake venoms. Toxicon X 2024; 24:100210. [PMID: 39398349 PMCID: PMC11471238 DOI: 10.1016/j.toxcx.2024.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 09/04/2024] [Accepted: 09/19/2024] [Indexed: 10/15/2024] Open
Abstract
Snakebites profoundly impact the rural population of tropical nations, leading to significant socio-economic repercussions. Polyvalent antivenom (PAV) therapy faces several limitations, including intra-specific variations and poor efficacy against some major toxins and low molecular mass, poorly immunogenic toxins, which contribute to increased mortality and morbidity rates. Innovative strategies for developing novel antivenoms are continuously explored to address these challenges. The present study focuses on designing of 17 epitope-string toxin-specific peptide immunogens from pharmacologically active major and/or poorly immunogenic toxins (snake venom metalloprotease, Kunitz-type serine protease inhibitor, phospholipase A2, three-finger toxin) from the venom of the 'Big Four' venomous snakes and Naja kaouthia (NK) in India. These custom peptide antibodies demonstrated robust immuno-reactivity against the venoms 'Big Four' and NK. When these antibodies were supplemented with commercial PAV at a defined ratio (formulated polyvalent antivenom or FPAV), it significantly enhanced the neutralization of snake venom enzymes and in vivo neutralization of lethality and pharmacological activities such as haemorrhage, necrosis, pro-coagulant, defibrinogenation, and myotoxicity of 'Big Four' and NK venoms compared to PAV in mice. The present study highlights a promising strategy for developing next-generation antivenoms using synthetic peptide-based immunogens, offering a targeted approach to address the limitations of current antivenom therapy.
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Affiliation(s)
- Abhishek Chanda
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, 784028, Assam, India
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, 97331, Oregon, USA
| | - Nitin C. Salvi
- Premium Serums and Vaccines Pvt. Ltd, Narayangaon, Pune, 410504, Maharashtra, India
| | - Pravin V. Shelke
- Premium Serums and Vaccines Pvt. Ltd, Narayangaon, Pune, 410504, Maharashtra, India
| | - Bhargab Kalita
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, 784028, Assam, India
- Amrita Research Centre, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, 121002, India
| | - Aparup Patra
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, 784028, Assam, India
- Amrita Research Centre, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, 121002, India
| | - Upasana Puzari
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, 784028, Assam, India
| | - Milind V. Khadilkar
- Premium Serums and Vaccines Pvt. Ltd, Narayangaon, Pune, 410504, Maharashtra, India
| | - Ashis K. Mukherjee
- Microbial Biotechnology and Protein Research Laboratory, Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, 784028, Assam, India
- Division of Life Sciences, Institute of Advanced Study in Science and Technology, Vigyan Path Garchuk, Paschim Boragaon, Guwahati, 781035, Assam, India
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25
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Chowdhury A, Fry BG, Samuel SP, Bhalla A, Vaiyapuri S, Bhargava P, Carter RW, Lewin MR. In vitro anticoagulant effects of Bungarus venoms on human plasma which are effectively neutralized by the PLA 2-inhibitor varespladib. Toxicon 2024; 252:108178. [PMID: 39547452 DOI: 10.1016/j.toxicon.2024.108178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 10/31/2024] [Accepted: 11/12/2024] [Indexed: 11/17/2024]
Abstract
Bungarus (krait) envenomings are well-known for their life-threatening neurotoxic effects. However, their impact on coagulation remains largely unexplored experimentally or clinically. This study, examined the effect of begins to examine venoms from four Bungarus species-B. caeruleus, B. candidus, B. fasciatus, and B. flaviceps on human platelet poor plasma coagulation parameters using thromboelastography and coagulation inhibition assays. B. flaviceps completely inhibited clotting, while B. caeruleus only delayed clot formation. In contrast, B. candidus and B. fasciatus did not affect clotting. Subsequent examinations into the anticoagulant biochemical mechanisms demonstrated divergent pathophysiological pathways. B. caeruleus venom anticoagulant effects were prevented by the addition of an excess of phospholipids, with anticoagulation thereby the result of phospholipid depletion. In contrast B. flaviceps anticoagulation was not affected by the addition of an excess of phospholipids. Further investigations demonstrated that B. flaviceps mediates its anticoagulant toxicity through the inactivation of coagulation enzymes. The anticoagulant effects of both B. flaviceps and B. caeruleus were nullified by varespladib, a phospholipase A2 (PLA2) inhibitor, revealing the toxin class involved. These results uncover previously unrecognized and unexplored anticoagulant effects of Bungarus venoms.
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Affiliation(s)
- Abhinandan Chowdhury
- Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia, QLD, 4072, Australia; Department of Biochemistry & Microbiology, North South University, Dhaka, Bangladesh
| | - Bryan G Fry
- Adaptive Biotoxicology Lab, School of the Environment, University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Stephen P Samuel
- Ophirex, Inc., Corte Madera, CA, 94925, USA; California Academy of Sciences, San Francisco, CA, 94118, USA
| | - Ashish Bhalla
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Parul Bhargava
- Department of Pathology and Laboratory Medicine, University of San Francisco, California, USA
| | | | - Matthew R Lewin
- Ophirex, Inc., Corte Madera, CA, 94925, USA; California Academy of Sciences, San Francisco, CA, 94118, USA.
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26
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Senthilkumaran S, Williams J, Almeida JR, Williams HF, Patel K, Thirumalaikolundusubramanian P, Vaiyapuri S. Snakebite-induced reversible cerebral vasoconstriction syndrome: Report of three cases. Toxicon 2024; 251:108161. [PMID: 39491731 DOI: 10.1016/j.toxicon.2024.108161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 10/21/2024] [Accepted: 11/01/2024] [Indexed: 11/05/2024]
Abstract
Envenomings from Russell's viper typically result in local tissue damage and bleeding complications, but the bites from common krait and cobra primarily cause neurotoxic effects. While most symptoms can be treated with appropriate antivenom, additional support is necessary for several snakebite victims to tackle a broad range of unusual complications that they develop following bites. Reversible vasoconstriction syndrome (RCVS), characterised by the constriction of cerebral arteries, is a rare but serious issue, presenting with severe headaches and, in extreme cases, haemorrhagic/ischaemic stroke. This report presents three cases of RCVS in snakebite victims following Russell's viper, krait and cobra bites. The patients were admitted to the hospital with neurological and/or haematological complications, and they were treated with polyvalent antivenom. After two days of antivenom treatment, all the patients developed intense headaches that lasted for several hours and failed to respond to commonly used analgesics. While the physical, laboratory and computed tomography examinations were normal, the RCVS was diagnosed with multimodal magnetic resonance angiography. All patients were successfully treated with oral nimodipine, and during their follow-ups, physical and laboratory examinations were unremarkable, and the magnetic resonance imaging confirmed the reversal of RCVS. To achieve positive outcomes in patients, clinicians must swiftly identify such rare complications and make accurate diagnoses to provide prompt treatments. Overall, this report presents an unusual complication of RCVS in snakebite patients and appropriate diagnosis and treatment approaches to tackle this condition.
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Affiliation(s)
| | - Jarred Williams
- School of Pharmacy, University of Reading, Reading, RG6 6UB, UK
| | - José R Almeida
- School of Pharmacy, University of Reading, Reading, RG6 6UB, UK
| | - Harry F Williams
- Toxiven Biotech Private Limited, Coimbatore, 641042, Tamil Nadu, India
| | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, RG6 6UB, UK
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27
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Rashmi U, Bhatia S, Nayak M, Khochare S, Sunagar K. Elusive elapids: biogeographic venom variation in Indian kraits and its repercussion on snakebite therapy. Front Pharmacol 2024; 15:1443073. [PMID: 39575383 PMCID: PMC11579489 DOI: 10.3389/fphar.2024.1443073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 10/21/2024] [Indexed: 11/24/2024] Open
Abstract
Snakebite is a major public health concern in many parts of the world, including India, where over 58,000 deaths occur annually due to snake envenoming. The common krait (Bungarus caeruleus) is responsible for the second-highest number of snakebite-related mortalities in the country. However, despite its notoriety, little is known about its venom ecology, functions and compositional variation across bioclimatic zones, partly because these nocturnal snakes are highly elusive, making it difficult to find them in the wild. We aim to address this knowledge gap by characterising the venom composition and toxicity profiles of the pan-Indian populations (n = 8) of B. caeruleus using a combination of proteomics, receptor-toxin interaction assays, biochemical experiments, pharmacological tests and preclinical evaluations. We reveal considerable variation in venom composition, functions, and pharmacological activities among the geographically distinct populations of B. caeruleus. Furthermore, toxin-receptor interaction assays provide insights into their feeding ecology and prey-predator interactions. Finally, in vitro and in vivo experiments revealed the poor neutralising potencies of Indian antivenoms towards most populations of the common krait. Our findings highlight the alarming need to develop efficacious snakebite therapy in India to treat bites from this medically most important elapid snake.
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Affiliation(s)
| | | | | | | | - Kartik Sunagar
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore, Karnataka, India
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28
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Salim A, Chandrasekharuni G, Almeida JR, Vaiyapuri R, Williams HF, Arumugam S, Senthilkumaran S, Patel K, Williams T, Norbert Zsidó A, Vaiyapuri S. Snake phobia among the general population of Tamil Nadu, India. PLoS Negl Trop Dis 2024; 18:e0012284. [PMID: 39499721 PMCID: PMC11567567 DOI: 10.1371/journal.pntd.0012284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 11/15/2024] [Accepted: 10/24/2024] [Indexed: 11/07/2024] Open
Abstract
BACKGROUND A specific phobia is an anxiety disorder that is characterised by persistent and excessive fear in the presence of the object of the phobia. Animal phobias are the most prevalent forms of specific phobia among humans. Fear of snakes (snake phobia) is present in non-human primates which suggests its evolutionary origins as the ability to detect the threat of snakes was critical for survival. Snake phobia is a critical factor in protecting snakes and mitigating snakebite burden. To date, only one standardised psychometric test [the Snake Questionnaire (SNAQ) developed in 1974] has been used to quantify snake phobia although this was not performed in snakebite-endemic countries. In this study, we aimed to determine snake phobia in India, where snakebites and resulting deaths, disabilities and socioeconomic impacts are high. METHODOLOGY/PRINCIPAL FINDINGS A modified version of the SNAQ (i.e. SNAQ12), which has previously demonstrated internal consistency, excellent reliability, and good discrimination between phobics and non-phobics in Europe was used in this study. SNAQ12 was developed both in English and Tamil and validated by testing on several individuals. Then, the final questionnaire was disseminated to members of the public through various methods including social media and in person through academic and clinical organisations. We received a total of 2032 responses, comprising 1086 [53.4%] males and 946 [46.6%] females, and these data were analysed to determine various aspects of snake phobia in the study population. CONCLUSIONS/SIGNIFICANCE The results demonstrated good internal consistency in using SNAQ12 to determine the phobia amongst the tested population. The data suggests that males are more snake-phobic in all age groups than females in India, in contrast to previous research that suggested that females are usually more snake-phobic. No other critical factors contribute to snake phobia in this study population. The use of the SNAQ12 allowed us to easily discriminate between individuals with phobia and non-clinical controls. This tool can be used as part of the One Health approach to better understand the relationships between snake phobia and snakebites and their impact on the mental health and well-being of vulnerable populations.
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Affiliation(s)
- Anika Salim
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Gnaneswar Chandrasekharuni
- School of Pharmacy, University of Reading, Reading, United Kingdom
- Madras Crocodile Bank Trust, Chennai, Tamil Nadu, India
| | - José R. Almeida
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | | | | | | | | | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - Timothy Williams
- Department of Psychology, University of Reading, Reading, United Kingdom
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29
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Srinivasan K, Nampoothiri M, Khandibharad S, Singh S, Nayak AG, Hariharapura RC. Proteomic diversity of Russell's viper venom: exploring PLA2 isoforms, pharmacological effects, and inhibitory approaches. Arch Toxicol 2024; 98:3569-3584. [PMID: 39181947 PMCID: PMC11489194 DOI: 10.1007/s00204-024-03849-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024]
Abstract
Snakebite envenomation is a serious health concern in tropical regions, resulting in high mortality. The World Health Organization (WHO) has declared it a neglected tropical disease and is working on strategies to reduce mortality. Russell's viper (Daboia russelii) is one of the most abundant venomous snakes found across Southeast Asia. Proteomic analysis of Russell's viper venom has demonstrated variation, with phospholipase A2 (PLA2) being the most abundant toxin across geographic boundaries. PLA2, a major constituent of the low-molecular-weight fraction of snake venom, hydrolyses phospholipids at the sn-2 position, releasing arachidonic acid and lysophospholipids. They are reported to cause various pharmacological effects, including hemolysis, anticoagulation, neurotoxicity, myotoxicity, and oedema. Though administration of antivenoms (ASV) is the primary treatment for envenomation, it has many drawbacks. Besides causing hypersensitivity reactions and life-threatening anaphylaxis, treatment with ASV is further complicated due to its inability to neutralize low-molecular-weight toxins. Thus, there is a greater need to produce next-generation antivenoms that can target specific toxins in the venom. In this review, we explored the classification of Russell's viper and the variation in its proteomic profile across Southeast Asia to date. In addition, we have also summarized the mechanism of action of PLA2 and discussed various isoforms of PLA2 found across different regions with their respective pharmacological effects. Finally, the drawbacks of commercially available antivenoms and the molecules investigated for inhibiting the low-molecular-weight toxin, PLA2 are discussed.
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Affiliation(s)
- Kishore Srinivasan
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Madhavan Nampoothiri
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shweta Khandibharad
- National Centre for Cell Science, NCCS Complex, Savitribai Phule Pune University Campus, Ganeshkhind, Pune, Maharashtra, India
| | - Shailza Singh
- National Centre for Cell Science, NCCS Complex, Savitribai Phule Pune University Campus, Ganeshkhind, Pune, Maharashtra, India
| | - Akshatha Ganesh Nayak
- Division of Biochemistry, Department of Basic Medical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Raghu Chandrashekar Hariharapura
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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30
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Gerardo CJ, Carter RW, Kumar S, Shirazi FM, Kotehal SD, Akpunonu PD, Bhalla A, Schwartz RB, Bammigatti C, Manikath N, Mukherjee PP, Arnold TC, Wolk BJ, S Sheikh S, Sollee DR, Vearrier DJ, Francis SJ, Aizenberg A, Kumar H, Ravikumar MK, Sarkar S, Haston T, Micciche A, Oomman SC, Owen JL, Ritter BA, Samuel SP, Lewin MR, Platts-Mills TF. Oral varespladib for the treatment of snakebite envenoming in India and the USA (BRAVO): a phase II randomised clinical trial. BMJ Glob Health 2024; 9:e015985. [PMID: 39442939 PMCID: PMC11499837 DOI: 10.1136/bmjgh-2024-015985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 10/02/2024] [Indexed: 10/25/2024] Open
Abstract
INTRODUCTION Snakebite envenoming (SBE) results in over 500 000 deaths or disabling injuries annually. Varespladib methyl, an oral inhibitor of secretory phospholipase A2, is a nearly ubiquitous component of snake venoms. We conducted a phase II clinical trial to assess efficacy and safety of oral varespladib methyl in patients bitten by venomous snakes. METHODS This double-blind, randomised, placebo-controlled trial enrolled patients in emergency departments in India and the USA. Patients with SBE were randomly assigned (1:1) to receive varespladib methyl or placebo two times per day for 1 week. All patients received standard of care, including antivenom. The primary outcome was change in the composite Snakebite Severity Score (SSS) measuring the severity of envenoming, from baseline to the average composite SSS at 6 and 9 hours. RESULTS Among 95 patients randomised August 2021 through November 2022, the most common snakebites were from Russell's vipers (n=29), copperheads (n=18) and rattlesnakes (n=14). The SSS improved from baseline to the average at 6 and 9 hours by 1.1 (95% CI, 0.7 to 1.6) in the varespladib group versus 1.5 (95% CI, 1.0 to 2.0) in the placebo group (difference -0.4, 95% CI, -0.8 to 0.1, p=0.13). While key secondary outcomes were not statistically different by treatment group, benefit was seen in the prespecified subgroup initiating study drug within 5 hours of bite (n=37). For this early treatment group, clinically important differences were observed for illness severity over the first week, patient-reported function on days 3 and 7 and complete recovery. No death or treatment emergent serious adverse event occurred. CONCLUSION For emergency department treatment of snakebites, the addition of varespladib to antivenom did not find evidence of difference for the primary outcome based on the SSS. A potentially promising signal of benefit was observed in patients initiating treatment within 5 hours of snakebite.
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Affiliation(s)
| | | | | | - Farshad M Shirazi
- University of Arizona Medical Center, University Campus, Tucson, Arizona, USA
| | | | - Peter D Akpunonu
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Ashish Bhalla
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | | | | | - Neeraj Manikath
- Government Medical College Kozhikode, Kozhikode, Kerala, India
| | - Partha P Mukherjee
- Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
| | - Thomas C Arnold
- Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Brian J Wolk
- Loma Linda University Medical Center, Loma Linda, California, USA
| | - Sophia S Sheikh
- University of Florida Health Science Center Jacksonville, Jacksonville, Florida, USA
| | - Dawn R Sollee
- University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
| | - David J Vearrier
- The University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Adiel Aizenberg
- University of Arizona Medical Center, University Campus, Tucson, Arizona, USA
| | - Harish Kumar
- Sardar Patel Medical College, Bikaner, Rajasthan, India
| | - Madhu K Ravikumar
- Mysore Medical College and Research Institute, Mysore, Karnataka, India
| | - Sujoy Sarkar
- Calcutta National Medical College and Hospital, Kolkata, West Bengal, India
| | - Taylor Haston
- Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Andrew Micciche
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Munshi H, Gavhande M, Bhad G, Mohanty B, Dash JP, Madavi K, Bansode M, Mohapatra A, Mahale SD, Pati S, Sachdeva G, Bawaskar HS, Gajbhiye R. Prevention & management of snakebite envenomation: A qualitative study on perspectives & practices in Maharashtra & Odisha. Indian J Med Res 2024; 159:356-368. [PMID: 39361800 PMCID: PMC11414789 DOI: 10.25259/ijmr_1566_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Indexed: 10/05/2024] Open
Abstract
Background & objectives Snakebite envenoming (SBE) is a major public health concern, with India bearing the highest global burden of SBE-related deaths. SBE is concentrated in rural and tribal regions of India, where the knowledge, attitude and behaviour of the dwelling communities largely influence mortality and morbidity. Understanding these factors is crucial to designing effective SBE prevention and management strategies. The present study's objective was to document the perspectives of community members and practices in selected blocks of Maharashtra and Odisha States regarding SBE prevention, first aid and health-seeking behaviour. Methods Between March and April 2022, 28 focus group discussions (FGDs) were conducted. Study sites included Shahapur block in Thane district, Aheri block in Gadchiroli district of Maharashtra, and Khordha block in Khordha district, Kasipur block in Rayagada district of Odisha. Separate FGDs were held for males (n=14) and females (n=14), involving about 8-16 participants above 18 yr. All discussions were audio recorded, and a grounded theory approach was employed to identify key themes from the translated transcripts. Results The findings of this study revealed a variety of perspectives and practices determining the SBE burden at the study sites. The findings included insufficient knowledge about snake species and their nature of toxicity, use of non-scientific first aid techniques, inaccessible health care and reliance on traditional healers, non-utilization of prevention methods, varied cultural beliefs and practices, and differential treatments based on gender. The findings have been collated in two simplistic frameworks; barriers to effective prevention and barriers to effective management. Interpretation & conclusions SBE burden results from a complex interplay between socioeconomic, cultural, and demographic factors, necessitating a collaborative inter-sectoral effort for adequate control. Through crucial regional inputs and the barriers to prevention and management models, this study provides critical insights and priority intervention areas to strengthen India's upcoming National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE) in all high-burden States.
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Affiliation(s)
| | | | | | | | | | - Kanna Madavi
- Sub District Hospital Aheri, Government of Maharashtra, Maharashtra, India
| | - Manohar Bansode
- Sub District Hospital Shahapur, Government of Maharashtra, Maharashtra, India
| | | | | | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Geetanjali Sachdeva
- ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
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Rajan K, Alangode A, Menon JC, Raveendran D, Nair SS, Reick M, Nair BG, Reick M, Vanuopadath M. Comparative functional characterization and in vitro immunological cross-reactivity studies on Daboia russelii and Craspedocephalus malabaricus venom. Trans R Soc Trop Med Hyg 2024; 118:682-696. [PMID: 38860309 DOI: 10.1093/trstmh/trae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/22/2024] [Accepted: 05/17/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Snake venom is a complex mixture of organic and inorganic constituents, including proteins and peptides. Several studies showed that antivenom efficacy differs due to intra- and inter-species venom variation. METHODS In the current study, comparative functional characterization of major enzymatic proteins present in Craspedocephalus malabaricus and Daboia russelii venom was investigated through various in vitro and immunological cross-reactivity assays. RESULTS The enzymatic assays revealed that hyaluronidase and phospholipase A2 activities were markedly higher in D. russelii. By contrast, fibrinogenolytic, fibrin clotting and L-amino acid oxidase activities were higher in C. malabaricus venom. ELISA results suggested that all the antivenoms had lower binding potential towards C. malabaricus venom. For D. russelii venom, the endpoint titration value was observed at 1:72 900 for all the antivenoms. In the case of C. malabaricus venom, the endpoint titration value was 1:2700, except for Biological E (1:8100). All these results, along with the avidity assays, indicate the strength of venom-antivenom interactions. Similarly, the western blot results suggest that all the antivenoms showed varied efficacies in binding and detecting the venom antigenic epitopes in both species. CONCLUSIONS The results highlight the need for species-specific antivenom to better manage snakebite victims.
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Affiliation(s)
- Karthika Rajan
- School of Biotechnology, Amrita Vishwa Vidyapeetham, Amritapuri, Clappana P.O , Kollam 690 525, Kerala, India
| | - Aswathy Alangode
- School of Biotechnology, Amrita Vishwa Vidyapeetham, Amritapuri, Clappana P.O , Kollam 690 525, Kerala, India
| | - Jaideep C Menon
- Preventive Cardiology & Population Health Sciences, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi 682 041 , Kerala, India
| | - Dileepkumar Raveendran
- Indriyam Biologics Pvt. Ltd, SCTIMST-TIMED, 5th Floor. M S Valiathan Building, BMT Wing - Poojappura, Thiruvananthapuram 695 012, Kerala, India
| | - Sudarslal Sadasivan Nair
- School of Biotechnology, Amrita Vishwa Vidyapeetham, Amritapuri, Clappana P.O , Kollam 690 525, Kerala, India
| | - Margaret Reick
- School of Biotechnology, Amrita Vishwa Vidyapeetham, Amritapuri, Clappana P.O , Kollam 690 525, Kerala, India
| | - Bipin Gopalakrishnan Nair
- School of Biotechnology, Amrita Vishwa Vidyapeetham, Amritapuri, Clappana P.O , Kollam 690 525, Kerala, India
| | - Martin Reick
- School of Biotechnology, Amrita Vishwa Vidyapeetham, Amritapuri, Clappana P.O , Kollam 690 525, Kerala, India
| | - Muralidharan Vanuopadath
- School of Biotechnology, Amrita Vishwa Vidyapeetham, Amritapuri, Clappana P.O , Kollam 690 525, Kerala, India
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Kakati H, Patra A, Mukherjee AK. Composition, pharmacology, and pathophysiology of the venom of monocled cobra (Naja kaouthia)- a medically crucial venomous snake of southeast Asia: An updated review. Toxicon 2024; 249:108056. [PMID: 39111718 DOI: 10.1016/j.toxicon.2024.108056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024]
Abstract
The Monocled Cobra (Naja kaouthia), a category one medically significant snake from the Elapidae family, inflicts severe envenomation in South and Southeast Asian countries. N. kaouthia is distributed throughout the eastern and northeastern parts of India, Nepal, Bangladesh, Myanmar, Thailand, Vietnam, Malaysia, and southwestern China. Envenomation by N. kaouthia is a medical emergency, and the primary clinical symptoms are neurotoxicity and localized tissue destruction. Unfortunately, data on the actual magnitude of N. kaouthia envenomation is scarce due to poor record keeping, lack of diagnostic kits, and region-wise well-coordinated epidemiological surveys. The present review highlights the diversity in the composition of N. Kaouthia venom (NKV) across various geographical regions, as revealed through biochemical and proteomic analyses. The qualitative and quantitative differences in the toxin isoforms result in differences in lethality and pathophysiological manifestation that may limit the effectiveness of antivenom therapy. Studies on commercial polyvalent antivenom (PAV) effectiveness against distinct NKV samples have revealed varying toxicity and enzymatic activity neutralization. Additionally, the identification of snake venom's poorly immunogenic toxins by mass spectrometry, quantification of venom-specific antibodies, and implications for antivenom therapy against snakebites are highlighted. Future directions involve clinical studies on NK envenomation where the snake is frequently encountered and the correlation of this data with NKV composition in that region. For more efficient and superior hospital management of NK envenomation, research should enhance the current immunization procedure to boost the development of antibodies against less immunogenic venom components of this snake.
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Affiliation(s)
- Hirakjyoti Kakati
- Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur- 784028, Assam, India
| | - Aparup Patra
- Institute of Advanced Studies in Science and Technology, Vigyan Path Garchuk, Paschim Boragaon, Guwahati-781035, Assam, India; Amrita Research Centre, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, 121002, India
| | - Ashis K Mukherjee
- Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur- 784028, Assam, India; Institute of Advanced Studies in Science and Technology, Vigyan Path Garchuk, Paschim Boragaon, Guwahati-781035, Assam, India.
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Biswas U, León-Ruiz M, Ghosh R, Bhattacharjee A, Mondal S, Benito-León J. Cerebral venous sinus thrombosis after Russell's viper ( Daboia russelii) envenomation: A case report. NEUROLOGY PERSPECTIVES 2024; 4:100176. [PMID: 40078502 PMCID: PMC11900894 DOI: 10.1016/j.neurop.2024.100176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/14/2025]
Affiliation(s)
- U. Biswas
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - M. León-Ruiz
- Section of Clinical Neurophysiology, Department of Neurology,University Hospital "La Paz", Madrid, Spain
| | - R. Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - A. Bhattacharjee
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - S.R. Mondal
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - J. Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
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Shetty VU. Mobile Critical Care in Resource-Limited Settings: An Unmet Need. Ann Glob Health 2024; 90:59. [PMID: 39309761 PMCID: PMC11414459 DOI: 10.5334/aogh.4506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 09/01/2024] [Indexed: 09/25/2024] Open
Abstract
Care of the critically ill in resource-limited areas, inside or outside the intensive care unit (ICU), is indispensable. Murthy and Adhikari noted that about 70% of patients in low-middle income (LMIC) areas could benefit from good critical care. Many patients in resource-limited settings still die before getting to the hospital. Investing in capacity building by strengthening and expanding ICU capability and training intensivists, critical care nurses, respiratory therapists, and other ICU staff is essential, but this process will take years. Also, having advanced healthcare facilities that are still far from remote areas will not do much to alleviate distance and mode of transportation as barriers to achieving good critical care. This paper discusses the importance of mobile critical care units (MCCUs) in supporting and enhancing existing emergency medical systems. MCCUs will be crucial in addressing critical delays in transportation and time to receive appropriate lifesaving critical care in remote areas. They are incredibly versatile and could be used to transfer severely ill patients to a higher level of care from the field, safely transfer critically ill patients between hospitals, and, sometimes, almost more importantly, provide standalone short-term critical care in regions where ICUs might be absent or immediately inaccessible. MCCUs should not be used as a substitute for primary care or to bypass readily available services at local healthcare centers. It is essential to rethink the traditional paradigm of 'prehospital care' and 'hospital care' and focus on improving the care of critically ill patients from the field to the hospital.
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Affiliation(s)
- Varun U. Shetty
- Intensivist, Cleveland Clinic, Clinical Assistant Professor, Case Western Reserve University Lerner College of Medicine, OH, USA
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36
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Barik AK, Mohanty CR, Behera S, Radhakrishnan RV. Snake envenomation in children: Experience from a tertiary care hospital in Northern India: Some concerns. Med J Armed Forces India 2024; 80:614-616. [PMID: 39309582 PMCID: PMC11411310 DOI: 10.1016/j.mjafi.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 08/03/2024] [Indexed: 09/25/2024] Open
Affiliation(s)
- Amiya Kumar Barik
- Assistant Professor (Anaesthesia & Intensive Care) Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Chitta Ranjan Mohanty
- Additional Professor & Head (Trauma & Emergency), All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Srikant Behera
- Assistant Professor (General Medicine), All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Kumar R, Rathore AS. Snakebite Management: The Need of Reassessment, International Relations, and Effective Economic Measures to Reduce the Considerable SBE Burden. J Epidemiol Glob Health 2024; 14:586-612. [PMID: 38856820 PMCID: PMC11442967 DOI: 10.1007/s44197-024-00247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024] Open
Abstract
The sole treatment for snakebite envenomation (SBE), the anti-snake venom (ASV), suffers from considerable drawbacks, including side effects and limited species specificity. Additionally, despite its existence for more than a century, uniform availability of good quality ASV does not yet exist. The present review describes the journey of a SBE victim and highlights the global crisis of SBE management. A detailed analysis of the current ASV market has also been presented along with the worldwide snake distribution. The current production of country specific licensed ASV throughout the globe along with their manufacturers has been examined at the snake species level. Furthermore, a detailed analysis of on-ground situation of SBE management in antivenom manufacturing countries has been done using the most recent literature. Additionally, the export and import of different ASVs have been discussed in terms of procurement policies of individual countries, their shortcomings, along with the possible solution at the species level. It is interesting to note that in most countries, the existence of ASV is really either neglected or overstated, implying that it is there but unsuitable for use, or that it is not present but can be obtained from other countries. This highlights the urgent need of significant reassessment and international collaborations not just for development and production, but also for procurement, distribution, availability, and awareness. A PROMISE (Practical ROutes for Managing Indigenous Snakebite Envenoming) approach has also been introduced, offering simple, economical, and easy to adopt steps to efficiently alleviate the worldwide SBE burden.
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Affiliation(s)
- Ramesh Kumar
- Department of Chemical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India
| | - Anurag S Rathore
- Department of Chemical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India.
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Menon JC, Nair B, Pati S, Pillay VV, Mahapatra A, Sreekrishnan TP, Vanuopadath M, John D, Nair SB, Sahoo PK, M S A, Sreedevi A, Jankiram C, Joseph JK. From neglect to equity in snakebite envenoming; what the ICMR-Collaborative Centre of Excellence (CCoE) targets. PLoS Negl Trop Dis 2024; 18:e0012425. [PMID: 39264864 PMCID: PMC11392331 DOI: 10.1371/journal.pntd.0012425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024] Open
Affiliation(s)
- Jaideep C Menon
- Professor, Adult Cardiology and Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Bipin Nair
- Professor & Dean, Amrita School of Biotechnology, Amrita Vishwa Vidyapeetham, Kollam, India
| | - Sanghamitra Pati
- Director, ICMR, Regional Medical Research Centre, Bhubaneswar, India
| | - Vijay V Pillay
- Head, Poison Control Centre and Department of Forensic Medicine & Toxicology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | | | - T P Sreekrishnan
- Consultant, Emergency Medicine & Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | | | - Denny John
- Professor, Faculty of Life and Allied Health Sciences, Ramaiah University of Applied Sciences, Bengaluru, India
| | - Sabarish B Nair
- Consultant, Emergency Medicine & Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Prakash K Sahoo
- Scientist D, ICMR, Regional Medical Research Centre, Bhubaneswar, India
| | - Aravind M S
- Research Associate, Department of Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Aswathy Sreedevi
- Professor & Head, Department of Community Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Chandrasekhar Jankiram
- Professor & Head, Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Joseph K Joseph
- Senior Consultant Nephrologist, Little Flower Hospital and Research Centre, Angamaly, India
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Salim A, Williams J, Almeida JR, Chandrasekharuni G, Williams HF, Vaiyapuri R, Vaiyapuri M, Viswanath R, Annamalai T, Patel K, Thirumalaikolundusubramanian P, Senthilkumaran S, Whitaker R, Vaiyapuri S. Challenges in rescuing snakes to protect human lives and promote snake conservation in Tamil Nadu, India. PLoS Negl Trop Dis 2024; 18:e0012516. [PMID: 39288194 PMCID: PMC11432882 DOI: 10.1371/journal.pntd.0012516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 09/27/2024] [Accepted: 09/06/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Human-snake conflicts are common worldwide, often resulting in snakebites. Snakebite envenoming causes over 125,000 deaths and 400,000 permanent disabilities worldwide every year. India alone accounts for an average of ~58,000 annual snakebite-induced deaths. As human developments rapidly expand into suburban and rural areas, snakes are being displaced and incidences of residents finding snakes within their dwellings are increasing. Most people have an innate fear of snakes, compounded by centuries of negative influence from culture and mythology manifesting in people often attempting to kill snakes. Snake rescuers are volunteers who remove and relocate snakes to safe areas. This is a risky job that poses potentially fatal implications if bitten. These volunteers mostly receive no financial compensation for their time or transportation costs, but they choose to do it for their love of snakes, conservation, and for the altruistic nature of helping others. Snake rescuers often receive no formal training and are unfunded resulting in removing snakes improperly without adequate safety equipment or the required skill set to safely complete the task. Therefore, it is critical to determine their challenges and requirements to promote the safe rescue of snakes while protecting human lives. METHODOLOGY/PRINCIPAL FINDINGS In this study, we developed an online questionnaire and interviewed 152 snake rescuers in Tamil Nadu, India following written informed consent to determine their challenges and needs for rescuing snakes safely. The results demonstrate that most rescuers are males, and they conduct snake rescues for varying lengths of time. They mostly receive no formal training and are bitten by snakes. They spend their own money on the purchase of snake-handling equipment and on treatments if bitten or injured during a rescue. CONCLUSIONS/SIGNIFICANCE The rescuers highlighted the urgent need for formal training, safety equipment and standard protocols for rescuing snakes in Tamil Nadu. Overall, this study demonstrates that snake rescuing should be appropriately regulated by the authorities, in particular the Wildlife Division of State Forest Departments in India, and formal training along with necessary equipment, medical insurance and appropriate recognition should be provided to them to safely remove snakes from human dwellings and manage the safety of both snakes and humans. They can also act as educators to disseminate information about the preventive and first aid measures for snakebites as well as the ecological importance of snakes.
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Affiliation(s)
- Anika Salim
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Jarred Williams
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Jose R. Almeida
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Gnaneswar Chandrasekharuni
- School of Pharmacy, University of Reading, Reading, United Kingdom
- Madras Crocodile Bank Trust, Mamallapuram, Tamil Nadu, India
| | | | | | | | - Rajan Viswanath
- Urvanam Foundation, Tamil Nadu Snake Conservation Forum, Madurai, Tamil Nadu, India
| | - Thanigaivel Annamalai
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, Karnataka, India
| | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, United Kingdom
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Kumar R, Kumar M, Kumar D, Raj A, Sheikh NA. Understanding pediatric snakebites: Clinical and epidemiological insights from a healthcare center in Bihar, India. J Family Med Prim Care 2024; 13:3011-3016. [PMID: 39228622 PMCID: PMC11368337 DOI: 10.4103/jfmpc.jfmpc_1817_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/21/2024] [Accepted: 02/05/2024] [Indexed: 09/05/2024] Open
Abstract
Background Snakebites are a common medical emergency and occupational hazard for children in India, particularly in rural areas where poverty is prevalent. However, there is limited data on the epidemiology of snakebites on the Indian subcontinent. Objective This cross-sectional, observational study aims to investigate the epidemiology, major clinical manifestations, and outcomes of snakebites in children under the age of 15 who were admitted to a tertiary care center in Bihar, a state in East India, and draw attention to this public health concern. Methods A cross-sectional observational study was conducted at the Department of Paediatrics, Patna Medical College and Hospital, Patna. The study included all cases of snakebites with features of envenomation involving patients less than 15 years of age who were brought to the department over a 2-year period. Data were collected using a data collection form and analyzed using the Statistical Package for the Social Sciences, version 11.0 (SPSS Inc., Chicago, IL, USA). Results A total of 59 cases were recorded, with 62.71% (n = 37) being male and 37.28% (n = 22) being female. Kraits were responsible for 38.9% (n = 23) of cases, vipers for 42.3% (n = 25), and cobras for 5% (n = 3). Fang marks were present in 67.7% (n = 40) of cases, and the majority of bites (84.7%, n = 50) occurred on a lower limb during the day. The age distribution showed that 16.9% (n = 10) were below 5 years old, 44% (n = 26) were between 5 and 10 years old, and 22% (n = 13) were above 10 years old. Traditional treatment was used in 44.7% (n = 22) of cases, with the most common treatments being local incision + tourniquet (22%, n = 13) and no traditional treatment (55.9%, n = 33). The highest number of cases occurred during July-September (35.5%, n = 21). Conclusion Snakebites are a significant public health issue in Bihar, India, with the majority of cases occurring in rural areas. The study highlights the importance of increased awareness and preparedness among healthcare providers and the general public, particularly during the monsoon season. Early hospital transfer, prehospital management, and prevention should be promoted through regular public health initiatives.
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Affiliation(s)
- Rajan Kumar
- Department of Pediatrics, AIIMS, Deoghar, Jharkhand, India
| | - Manoj Kumar
- Department of Pediatrics, AIIMS, Patna, Bihar, India
| | - Deepak Kumar
- Department of Pediatrics, AIIMS, Deoghar, Jharkhand, India
| | - Akanksha Raj
- Department of Obstetrics and Gynecology, ANMMCH, Gaya, Bihar, India
| | - Nishat A. Sheikh
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
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Senji Laxme RR, Khochare S, Bhatia S, Martin G, Sunagar K. From birth to bite: the evolutionary ecology of India's medically most important snake venoms. BMC Biol 2024; 22:161. [PMID: 39075553 PMCID: PMC11287890 DOI: 10.1186/s12915-024-01960-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Snake venoms can exhibit remarkable inter- and intraspecific variation. While diverse ecological and environmental factors are theorised to explain this variation, only a handful of studies have attempted to unravel their precise roles. This knowledge gap not only impedes our understanding of venom evolution but may also have dire consequences on snakebite treatment. To address this shortcoming, we investigated the evolutionary ecology of venoms of Russell's viper (Daboia russelii) and spectacled cobra (Naja naja), India's two clinically most important snakes responsible for an alarming number of human deaths and disabilities. METHODOLOGY Several individuals (n = 226) of D. russelii and N. naja belonging to multiple clutches (n = 9) and their mothers were maintained in captivity to source ontogenetic stage-specific venoms. Using various in vitro and in vivo assays, we assessed the significance of prey, ontogeny and sex in driving venom composition, function, and potency. RESULTS Considerable ontogenetic shifts in venom profiles were observed in D. russelii, with the venoms of newborns being many times as potent as juveniles and adults against mammalian (2.3-2.5 ×) and reptilian (2-10 ×) prey. This is the first documentation of the ontogenetic shift in viperine snakes. In stark contrast, N. naja, which shares a biogeographic distribution similar to D. russelii, deployed identical biochemical cocktails across development. Furthermore, the binding kinetics of cobra venom toxins against synthetic target receptors from various prey and predators shed light on the evolutionary arms race. CONCLUSIONS Our findings, therefore, provide fascinating insights into the roles of ecology and life history traits in shaping snake venoms.
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Affiliation(s)
- R R Senji Laxme
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore, 560012, Karnataka, India
| | - Suyog Khochare
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore, 560012, Karnataka, India
| | - Siddharth Bhatia
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore, 560012, Karnataka, India
| | - Gerard Martin
- The Liana Trust. Survey, #1418/1419 Rathnapuri, Hunsur, 571189, Karnataka, India
| | - Kartik Sunagar
- Evolutionary Venomics Lab, Centre for Ecological Sciences, Indian Institute of Science, Bangalore, 560012, Karnataka, India.
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Guru S, Bellapukonda S, Mohanty CR, Radhakrishnan RV, Gupta A. A rare manifestation of serum sickness after common krait envenomation in a patient treated with polyvalent anti-snake venom in India: Presentation and challenges. J Family Med Prim Care 2024; 13:2792-2794. [PMID: 39071008 PMCID: PMC11272001 DOI: 10.4103/jfmpc.jfmpc_417_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/20/2023] [Accepted: 01/17/2024] [Indexed: 07/30/2024] Open
Abstract
Envenomation from snakebites is a significant public health concern in the Southeast Asian region resulting in considerable mortality and morbidity. Anti-snake venom (ASV) despite being the only rescue can bring forth several acute and delayed adverse effects. Among them, serum sickness is a late manifestation after treatment with ASV that presents after 5-14 days of treatment. However, there is no specific definition to diagnose serum sickness or proven treatment. Here, we present a case of serum sickness to provide an insight into this unventured zone, briefing the presentation, treatment and probable reason for serum sickness and its prevention after common krait envenomation and treatment with polyvalent ASV in India.
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Affiliation(s)
- Satyabrata Guru
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Snigda Bellapukonda
- Department of Anaesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Chitta R. Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Anju Gupta
- Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Verma P, Nair GR. Serpents and thermometers: Connecting the dots between climate change and the growing menace of snakebites. J Family Med Prim Care 2024; 13:2797-2798. [PMID: 39070998 PMCID: PMC11272009 DOI: 10.4103/jfmpc.jfmpc_293_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/07/2024] [Indexed: 07/30/2024] Open
Affiliation(s)
- Prerna Verma
- Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Gayatri R. Nair
- Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
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Sandesha VD, Naveen P, Manikanta K, Mahalingam SS, Girish KS, Kemparaju K. Hump-Nosed Pit Viper ( Hypnale hypnale) Venom-Induced Irreversible Red Blood Cell Aggregation, Inhibition by Monovalent Anti-Venom and N-Acetylcysteine. Cells 2024; 13:994. [PMID: 38920625 PMCID: PMC11201549 DOI: 10.3390/cells13120994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
Envenomation by the Hypnale hypnale in the Western Ghats of India (particularly in the Malabar region of Kerala) and the subcontinent island nation of Sri Lanka is known to inflict devastating mortality and morbidity. Currently, H. hypnale bites in India are devoid of anti-venom regimens. A detailed characterization of the venom is essential to stress the need for therapeutic anti-venom. Notably, the deleterious effects of this venom on human blood cells have largely remained less explored. Therefore, in continuation of our previous study, in the present study, we envisioned investigating the effect of venom on the morphological and physiological properties of red blood cells (RBCs). The venom readily induced deleterious morphological changes and, finally, the aggregation of washed RBCs. The aggregation process was independent of the ROS and the intracellular Ca2+ ion concentration. Confocal and scanning electron microscopy (SEM) images revealed the loss of biconcave morphology and massive cytoskeletal disarray. Crenation or serrated plasma membrane projections were evenly distributed on the surface of the RBCs. The venom did not cause the formation of methemoglobin in washed RBCs but was significantly induced in whole blood. Venom did not affect glucose uptake and Na+/K+ -ATPase activity but inhibited glucose 6 phosphate dehydrogenase activity and decreased the fluidity of the plasma membrane. Venom-induced RBC aggregates exhibited pro-coagulant activity but without affecting platelet aggregation. In pre-incubation or co-treatment studies, none of the bioactive compounds, such as melatonin, curcumin, fisetin, berberine, and quercetin, sugars such as mannose and galactose, and therapeutic polyvalent anti-venoms (Bharat and VINS) were inhibited, whereas only N-acetylcysteine and H. hypnale monovalent anti-venom could inhibit venom-induced deleterious morphological changes and aggregation of RBCs. In post-treatment studies, paradoxically, none of the bioactives and anti-venoms, including N-acetylcysteine and H. hypnale monovalent anti-venom, reversed the venom-induced RBC aggregates.
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Affiliation(s)
- Vaddaragudisalu D. Sandesha
- Department of Studies in Biochemistry, University of Mysore, Manasagangotri, Mysuru 570006, Karnataka, India; (V.D.S.); (P.N.); (K.M.)
| | - Puttaswamy Naveen
- Department of Studies in Biochemistry, University of Mysore, Manasagangotri, Mysuru 570006, Karnataka, India; (V.D.S.); (P.N.); (K.M.)
| | - Kurnegala Manikanta
- Department of Studies in Biochemistry, University of Mysore, Manasagangotri, Mysuru 570006, Karnataka, India; (V.D.S.); (P.N.); (K.M.)
| | - Shanmuga S. Mahalingam
- Department of Biological Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Kesturu S. Girish
- Department of Studies and Research in Biochemistry, Tumkur University, Tumakuru 572103, Karnataka, India
| | - Kempaiah Kemparaju
- Department of Studies in Biochemistry, University of Mysore, Manasagangotri, Mysuru 570006, Karnataka, India; (V.D.S.); (P.N.); (K.M.)
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Nandana MB, Bharatha M, Praveen R, Nayaka S, Vishwanath BS, Rajaiah R. Dimethyl ester of bilirubin ameliorates Naja naja snake venom-induced lung toxicity in mice via inhibiting NLRP3 inflammasome and MAPKs activation. Toxicon 2024; 244:107757. [PMID: 38740099 DOI: 10.1016/j.toxicon.2024.107757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
Naja naja snake bite causes thousands of deaths worldwide in a year. N. naja envenomed victims exhibit both local and systemic reactions that potentially lead to death. In clinical practice, pulmonary complications in N. naja envenomation are commonly encountered. However, the molecular mechanisms underlying N. naja venom-induced lung toxicity remain unknown. Here, we reasoned that N. naja venom-induced lung toxicity is prompted by NLRP3 inflammasome and MAPKs activation in mice. Treatment with dimethyl ester of bilirubin (BD1), significantly inhibited the N. naja venom-induced activation of NLRP3 inflammasome and MAPKs both in vivo and in vitro (p < 0.05). Further, BD1 reduced N. naja venom-induced recruitment of inflammatory cells, and hemorrhage in the lung toxicity examined by histopathology. BD1 also diminished N. naja venom-induced local toxicities in paw edema and myotoxicity in mice. Furthermore, BD1 was able to enhance the survival time against N. naja venom-induced mortality in mice. In conclusion, the present data showed that BD1 alleviated N. naja venom-induced lung toxicity by inhibiting NLRP3 inflammasome and MAPKs activation. Small molecule inhibitors that intervene in venom-induced toxicities may have therapeutic applications complementing anti-snake venom.
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Affiliation(s)
- Manuganahalli B Nandana
- Department of Studies in Biochemistry, University of Mysore, Manasagangotri, Mysore, Karnataka, 570006, India; Department of Studies in Molecular Biology, University of Mysore, Manasagangotri, Mysore, Karnataka, 570006, India
| | - Madeva Bharatha
- Department of Studies in Biochemistry, University of Mysore, Manasagangotri, Mysore, Karnataka, 570006, India
| | - Raju Praveen
- Department of Studies in Biochemistry, University of Mysore, Manasagangotri, Mysore, Karnataka, 570006, India
| | - Spandan Nayaka
- Department of Studies in Biochemistry, University of Mysore, Manasagangotri, Mysore, Karnataka, 570006, India
| | - Bannikuppe S Vishwanath
- Department of Studies in Biochemistry, University of Mysore, Manasagangotri, Mysore, Karnataka, 570006, India.
| | - Rajesh Rajaiah
- Department of Studies in Molecular Biology, University of Mysore, Manasagangotri, Mysore, Karnataka, 570006, India.
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Stephen S, Mohanty CR, Radhakrishnan RV, Issac A, Jacob J, Krishnan N, Vr V, Guru S, Muhammed Shaji I, Aggarwal A. Clinico-Epidemiological Profile, Trends, and Health-Related Outcomes of Snakebite Victims: A One-Year Prospective Study from Eastern India. Wilderness Environ Med 2024; 35:155-165. [PMID: 38634117 DOI: 10.1177/10806032241239628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Snakebite envenomation is a significant life-threatening public health problem in Southeast Asia (SEA). In this region, India reported the largest number of snakebite deaths from 2000 to 2019 (1.2 million), with an average of 58,000 deaths yearly. METHODS This prospective observational study was carried out among snakebite victims at the emergency department (ED) of a tertiary care public sector hospital in eastern India. RESULTS A total of 145 cases of venomous snakebite were investigated. More than half (n = 81, 56%) of the snakebite victims were between 17 to 45 years. Most of the snakebite victims were male (68%) and were farmers (53%) by occupation. The majority of snakebites occurred during the daytime (76%) and while outdoors (67%). Most victims sustained a bite on the lower extremity (71%). The peak incidence of snakebites occurred from June to September (69%). Three-quarters of all patients were unaware of the required first aid measures following a snakebite. Among the 145 venomous snakebites, 48 were presumptively identified as the Indian cobra, 32 by the Indian krait, 56 by the Russel's viper, and 9 by saw-scaled viper. The mean duration from the snakebite to the onset of systemic effects in the Indian cobra was 52 ± 14.28 min, 66 ± 18.35 min in the Indian krait, 42 ± 13.47 min in Russel's viper, and 48 ± 16.38 min in saw-scaled viper. Respiratory failure was the commonly observed complication following an elapid envenomation. The mortality rate was 2.1% among the patients treated with antivenom. CONCLUSIONS Snakebite is considered an occupational hazard in India, commonly affecting the young population in their productive period. The peak incidence was during monsoon season, and the majority had neurotoxic envenomation following an elapid bite (55%) that contributed to the increased mortality and morbidity among young adults. Of the 145 patients, the majority (84%) recovered fully with treatment; 16% of the victims developed morbidity viz cellulitis, respiratory failure, acute renal failure, compartment syndrome, local tissue necrosis, intracerebral hemorrhage, and disseminated intravascular coagulation. Appropriate first aid measures and timely medical intervention can significantly improve the treatment outcome following snakebites.
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Affiliation(s)
- Shine Stephen
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | | | - Alwin Issac
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Jaison Jacob
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Nadiya Krishnan
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Vijay Vr
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Raebareli, India
| | - Satyabrata Guru
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Achala Aggarwal
- Department of Nursing Services, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Naz H, Chamola R, Sarafraz J, Razabizadeh M, Jain S. An efficient densenet-based deep learning model for Big-4 snake species classification. Toxicon 2024; 243:107744. [PMID: 38701904 DOI: 10.1016/j.toxicon.2024.107744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/19/2024] [Accepted: 04/30/2024] [Indexed: 05/05/2024]
Abstract
Snakebite poses a significant health threat in numerous tropical and subtropical nations, with around 5.4 million cases reported annually, which results in 1.8-2.7 million instances of envenomation, underscoring its critical impact on public health. The 'BIG FOUR' group comprises the primary committers responsible for most snake bites in India. Effective management of snakebite victims is essential for prognosis, emphasizing the need for preventive measures to limit snakebite-related deaths. The proposed initiative seeks to develop a transfer learning-based image classification algorithm using DenseNet to identify venomous and non-venomous snakes automatically. The study comprehensively evaluates the image classification results, employing accuracy, F1-score, Recall, and Precision metrics. DenseNet emerges as a potent tool for multiclass snake image classification, achieving a notable accuracy rate of 86%. The proposed algorithm intends to be incorporated into an AI-based snake-trapping device with artificial prey made with tungsten wire and vibration motors to mimic heat and vibration signatures, enhancing its appeal to snakes. The proposed algorithm in this research holds promise as a primary tool for preventing snake bites globally, offering a path toward automated snake capture without human intervention. These findings are significant in preventing snake bites and advancing snakebite mitigation strategies.
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Affiliation(s)
- Huma Naz
- School of Computer Science and Engineering, University of Petroleum and Energy Studies Dehradun, India
| | - Rahul Chamola
- Department of Mechanical Engineering, School of Advanced Engineering, University of Petroleum and Energy Studies, Dehradun, India.
| | - Jaleh Sarafraz
- UMR7179 CNRS/MNHN, Département Àdaptations du vivant, Museum National d'Histoire Naturelle, Paris, France
| | - Mahdi Razabizadeh
- Department of Biodiversity, Institute of Science and High Technology and Environmental Sciences, Graduate University of Advanced Technology, Kerman, Iran.
| | - Siddharth Jain
- Department of Mechanical Engineering, School of Advanced Engineering, University of Petroleum and Energy Studies, Dehradun, India
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Shankar T, Arora P, Jose JR, Kaushik A. Thrombotic microangiopathy following a white-lipped pit viper envenomation. BMJ Case Rep 2024; 17:e258813. [PMID: 38782420 DOI: 10.1136/bcr-2023-258813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Certain snake envenomation patients with consumptive coagulopathy, termed venom-induced consumption coagulopathy, develop thrombotic microangiopathy (TMA). Due to predominant renal involvement, TMA is said to resemble haemolytic uraemic syndrome and is treated with haemodialysis. We present a case of a young male who presented to the emergency department after being bitten by a white-lipped pit viper (Trimeresurus albolabris). He developed heart failure in addition to acute kidney injury secondary to TMA. He was treated with 30 vials of anti-snake venom according to national guidelines and underwent haemodialysis. Despite haemodialysis, the patient's ventilatory parameters continued to worsen, necessitating invasive mechanical ventilation. Thus, he was initiated on plasma exchange therapy, to which the patient responded well. TMA has not been reported in Trimeresurus envenomations yet, to the best of our knowledge. Additionally, plasma exchange therapy can be considered an adjunctive therapy for snakebite patients who develop TMA.
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Affiliation(s)
- Takshak Shankar
- Emergency Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Poonam Arora
- Emergency Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Jewel Rani Jose
- Emergency Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Aseem Kaushik
- Emergency Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
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Mb L, Parmar DS, Singh S, Britto C. An indigenously developed tele-ICU model to treat severe cases of envenomation in remote regions in India. BMJ Case Rep 2024; 17:e255786. [PMID: 38782437 DOI: 10.1136/bcr-2023-255786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
In cases of severe envenomation due to snakebites, patients require antivenom, intensive care management, including respiratory support, haemodynamic monitoring and renal replacement therapy. Early recognition and treatment of complications such as acute kidney injury, rhabdomyolysis and coagulopathy are important to improve outcomes.Tele-ICU models can play a critical role in providing access to critical care expertise and nuanced support to remote healthcare facilities that may not have the necessary resources or expertise to manage complex cases of envenomation. With the help of telemedicine technology, remote intensivists can provide timely guidance on diagnosis and ongoing management, improving the quality of care and outcomes for patients. We discuss two patients in resource-constrained regions of India with severe envenomation who were managed with tele-ICU support.
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Affiliation(s)
- Lokesh Mb
- Cloudphysician Healthcare Pvt Ltd, Bengaluru, India
| | | | | | - Carl Britto
- Division of Critical CareDepartment of Anaesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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50
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Singh P, Jayaraman G. Inhibition of the Naja naja venom toxicity by polymeric nanoparticles loaded with Leucas aspera methanolic extract. Front Pharmacol 2024; 15:1385213. [PMID: 38783952 PMCID: PMC11112068 DOI: 10.3389/fphar.2024.1385213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Background Snakebite is a neglected tropical disease that affects millions of people worldwide. Developing effective treatments can make a significant contribution to global health efforts and public health initiatives. To reduce mortality due to snakebite, there is an immediate need to explore novel and effective treatment methodologies. In that context, nanoparticle-based drug delivery is gaining a lot of attention. Hydrophilic nanoparticles are suitable for the delivery of therapeutic peptides, proteins, and antigens. Methods The present investigation is aimed at evaluating the anti-ophidian potential of the methanolic extract of the ethno-medicinal herb Leucas aspera (Willd.) loaded within chitosan nanoparticles (CNP-LA), against the Indian cobra (Naja naja) venom enzymes. For this purpose, nanoparticles were prepared using the ionic gelation method to enhance the efficacy of the extract. The physicochemical and structural features of nanoparticles were investigated using dynamic light scattering (DLS), Fourier-transform Infrared (FTIR), field emission scanning electron microscopy (FE-SEM), and X-ray diffraction (XRD) techniques. Results It was found that CNP-LA has an average size of 260 nm with a polydispersity index of 0.132 (PDI) and zeta potential of 34.7 mV, with an encapsulation efficiency of 92.46%. The in vitro release study was performed at pH 5.0 and 7.4. Furthermore, in vitro studies indicated that CNP-LA inhibited the phospholipase A2, hemolytic, and caseinolytic activities of Naja naja venom with the percentage inhibition of 92.5%, 83.9%, and 94.5%, respectively. Conclusion This is the first report on the application of herbal methanolic extract loaded within chitosan nanoparticles for neutralizing snake venom enzymes with increased efficiency.
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Affiliation(s)
| | - Gurunathan Jayaraman
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
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