妊娠期毒蛇咬伤6例临床分析

[目的]探讨妊娠期毒蛇咬伤的处理与母婴预后。[方法]6例妊娠期毒蛇咬伤患者均采用抗蛇毒血清和抗生素治疗。[结果]6例毒蛇咬伤孕妇均无临床并发症并治愈出院,其中5例妊娠晚期毒蛇咬伤剖宫产患者,母婴预后良好,1例中孕患者因担忧蛇毒及药物对胎儿的影响而终止妊娠。[结论]妊娠期毒蛇咬伤母婴预后与患者孕期、就诊时间及医务人员处理相关。     

Establishment and first experiences of the National Serum Depot in the Netherlands

Since 2008, a National Serum Depot is operational in the Netherlands, guaranteeing antivenom supply, 24 h per day, during medical emergencies. In this article the organisation structure, choice of antivenoms, problems encountered during the establishment, and the results from establishment in 2008 till December 2011 are discussed.The Serum Depot is organised by the National Institute for Public Health and the Environment in cooperation with the Dutch National Poisons Information Center. During establishing and maintaining of the Serum Depot several antivenom purchase difficulties were encountered. Some antivenom producers did not respond upon (initial) contact and some antivenoms were (temporarily) unavailable. Good contacts with professional herpetologists are necessary in order to keep the content of the depot up-to-date. At the same time, it is important to remain well informed concerning the safety and efficacy of the currently available antivenoms and development of new antivenoms.During the first four years of the National Serum Depot, the Dutch National Poisons Information Center was consulted on average 10 times a year about exotic venomous bites and stings in which antivenom treatment might play a role. Almost half of these consultations were related to bites by venomous exotic snakes, the other half to scorpion and fish stings. Antivenom was delivered in five cases, all after a bite by an exotic venomous snake, and actually administered twice because of the severity of local effects.To reduce costs and extend coverage of the Serum Depot of antivenoms for more unfamiliar snake species, international cooperation between the various owners of the antivenom Serum Depots in Europe is recommended.     

How can monoclonal antibodies be harnessed against neglected tropical diseases and other infectious diseases?

ABSTRACT

Introduction: Monoclonal antibody-based therapies now represent the single-largest class of molecules undergoing clinical investigation. Although a handful of different monoclonal antibodies have been clinically approved for bacterial and viral indications, including rabies, therapies based on monoclonal antibodies are yet to fully enter the fields of neglected tropical diseases and other infectious diseases.

Areas covered: This review presents the current state-of-the-art in the development and use of monoclonal antibodies against neglected tropical diseases and other infectious diseases, including viral, bacterial, and parasitic infections, as well as envenomings by animal bites and stings. Additionally, a short section on mushroom poisonings is included. Key challenges for developing antibody-based therapeutics are discussed for each of these fields.

Expert opinion: Neglected tropical diseases and other infectious diseases represent a golden opportunity for academics and technology developers for advancing our scientific capabilities within the understanding and design of antibody cross-reactivity, use of oligoclonal antibody mixtures for multi-target neutralization, novel immunization methodologies, targeting of evasive pathogens, and development of fundamentally novel therapeutic mechanisms of action. Furthermore, a huge humanitarian and societal impact is to gain by exploiting antibody technologies for the development of biotherapies against diseases, for which current treatment options are suboptimal or non-existent.     

Reversal of experimental paralysis in a human by intranasal neostigmine aerosol suggests a novel approach to the early treatment of neurotoxic envenomation

Neurotoxic snake envenomation can result in respiratory failure and death. Early treatment is considered important to survival. Inexpensive, heat‐stable, needle‐free, antiparalytics could facilitate early treatment of snakebite and save lives, but none have been developed. An experiment using aerosolized neostigmine to reverse paralysis suggests how early interventions could be developed.     

Bedside Whole-Blood Clotting Times: Validity after Snakebites

Background

Venomous snakebites contribute to morbidity and mortality throughout the world, most commonly in resource-poor areas, with about 2.5 million humans sustaining snakebites annually. Coagulopathy is a significant cause of both morbidity and mortality in these patients. In the absence of more sophisticated hematological studies or obvious physical findings, many clinicians must rely on whole-blood clotting times to assess whether their patients are coagulopathic. Alternative (bedside) methods to assess clotting times are often officially recommended and used, but have not been validated.

Objective

We assessed two bedside methods for measuring whole-blood clotting time after snakebites for their congruence with results from a hospital laboratory.

Methods

Over a 5-month period, 46 sequential patients presenting with a possible snakebite had blood drawn for bedside (using syringe and ceftriaxone bottle as containers) and laboratory whole-blood clotting tests. All three tests used ∼5 mL whole blood and looked for any clot formation within 20 min.

Results

Compared to the laboratory, the syringe method correctly classified the patients 84.7% of the time (sensitivity 88.9%; specificity 82.4%). The bottle method correctly classified the patients 86.8% of the time (sensitivity 83.3%; specificity 90.0%). Comparing the area under the Receiver Operator Characteristics curves shows that both the syringe and bottle methods do not differ in their discrimination for identifying clotting.

Conclusions

Both the syringe and ceftriaxone bottle bedside clotting test methods appear to be accurate enough to help guide therapy after potential snake envenomations when formal laboratory testing is unavailable.     

Geographic Information System mapping of snakebite incidence in northern Ghana and Nigeria using environmental indicators: a preliminary study

Snakebite is an important health problem in many parts of rural West Africa where the carpet or sawscaled viper, Echis ocellatus, is responsible for most of the morbidity and mortality. Marked seasonal and geographical variation in the incidence of snakebite suggests an association with environmental factors that could potentially identify high-risk areas and inform health care decision making. This preliminary investigation describes a Geographic Information System (GIS) approach to risk mapping that identifies environmental variables potentially associated with variation in snakebite incidence rates at a number of health facilities in northern Ghana and Nigeria and which has been used to create a preliminary risk map of the potential probability of high snakebite incidence for West Africa. Detailed and extensive further studies will enable the more reliable estimation of snakebite incidence at a local level across the region.     

中西医结合治疗毒蛇咬伤疗效分析

目的 观察中西结合治疗毒蛇咬伤的方法和疗效,分析与其病情轻重及病程长短相关的指标,为临床诊治提供理论依据。方法 回顾性分析2013年4月至2014年11月安徽中医药大学第一附属医院急诊科收治的232例毒蛇咬伤患者,根据患者入院第5天复查的肝酶、心肌酶、肾功能、凝血功能、炎症指标情况分为治愈组 (151例)、好转组(81例),对其临床资料进行统计学分析。结果 住院第5天,232例住院患者的肝酶、心肌酶、肾功能、凝血功能、炎症指标均恢复正常或明显下降,没有患者遗留有器官功能障碍。与治愈组患者比较,好转组患者入院24 h的丙氨酸氨基转移酶(ALT)、尿素氮(BUN)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、总胆红素(TIBL)、白细胞计数(WBC) (P＜0.05)增高明显;进一步Logistic 回归分析显示:年龄(>60岁)、丙氨酸氨基转移酶(>50 U·L-1)、肌酸激酶同工酶(>24 U·L-1)升高是影响毒蛇咬伤患者疗程及疗效的独立预报因子(均P＜0.05)。结论 年龄、丙氨酸氨基转移酶、肌酸激酶同工酶,可作为临床预判毒蛇咬伤患者病情轻重及疗程长短的有价值指标。     

蛇伤后饮酒对伤肢肿胀及组胺影响的临床研究

目的探究民间传统以酒助行药力治疗火毒证蛇伤的可行性。方法实验分为饮酒的观察组和未饮酒的对照组各30例,采用相同的诊断标准、纳入标准、排除标准和治疗方案,分别观测记录伤肢肿胀加剧时间和持续时间(以小时计数),两组均于蛇伤后第4天清晨空腹抽肘静脉血,采用酶联免疫分析(ELISA)法检测人体组胺,用SPSS 16.0统计软件采用配对t检验进行统计学数据分析。结果均P0.05有统计学意义。结论临床证据和实验数据证明火毒证蛇伤后饮酒是错误的,饮酒能助行药力的思维是错误的,应当选择性地继承传统治疗手段,基于中医学"既病防变"的理念,倡导正确处理,进而提高火毒证毒蛇咬伤的救治水平,降低医疗费用,节约社会医疗资源。     

Tracheal intubation prevented with administration of Fab antivenom after severe crotaline envenomation

Background: Crotaline snake envenomations are common, but severe crotaline envenomations are infrequent. Death from severe envenomation is usually from upper airway edema and respiratory failure. Published reports of severe respiratory compromise and anaphylactoid reactions are rare. Currently, FabAV (Crotalidae polyvalent immune Fab [Ovine] [CroFab]) is the mainstay of crotaline envenomation treatment; however, FabAV has been approved for only mild and moderate envenomations. Case report: We describe a case of a male with severe systemic effects and airway compromise after crotaline envenomation. The patient's systemic effects and upper airway edema substantially improved after antivenom infusion and before epinephrine administration. Endotracheal intubation was averted, clinical deterioration was avoided, and improvement occurred after prompt FabAV use. Conclusion: Fab antivenom likely prevented endotracheal intubation in our case of severe crotaline envenomation.