Call for global snake-bite control and procurement funding
2001; Elsevier BV; Volume: 357; Issue: 9262 Linguagem: Inglês
10.1016/s0140-6736(00)04286-0
ISSN1474-547X
Autores Tópico(s)Healthcare and Venom Research
ResumoPolyvalent snake antivenom, discussed by R Theakston and D Warrell,1Theakston RDG Warrell DA Crisis in snake antivenom supply for Africa.Lancet. 2000; 356: 2104Summary Full Text Full Text PDF PubMed Scopus (120) Google Scholar is prepared by immunisation of animals (horse, goat, sheep, &c) with snake venom. Antivenom is the only specific life-saving measure for the treatment of snake bites, but is expensive and is not free from anaphylaxis. Antivenom should, therefore, be used only in patients in whom the benefits of treatemt are judged to exceed the risk.The dose of antivenom is not fixed, but the indications are known.2Warrell DA The clinical managment of snake bites in the Southeast.Asian J Trop Med Publick Health. 1999; 30: S1-S67Google Scholar In a neuroparalysis due to elapidae envenoming, antivenom treatment alone cannot be relied upon to save life.Poisonous snakes (Bungarus caerelus, Cobra,Echis carinatus, Russell's viper), scorpion (Mesobuthus tamulus), flourish in western Maharashtra.3Bawaskar HS Bawaskar PH Envenoming by scorpions and snakes (elapidae), their neurotoxins and therapeutics.Trop Doct. 2000; 30: 23-25PubMed Google Scholar The cost of one ampoule of snake antivenom is 365 rupees (UK £5·36) and of scorpion antivenom is 242 rupees (UK £3·36), and are always in short supply. We analysed the total cases of snake bites and scorpion stings treated in 1999 (Jan-Dec) at funded general hospitals and private hospitals in the Raigad districts. Victims of snake bites and scorption stings report to general hospitals for free treatment. The medical officer frequently has never treated a case of scorpion sting or snake bite before. Much antivenom is, therefore, wasted by non-indicated use (table).Scorpion venom opens neuronal sodium channels resulting in antonomic storm, thus scorpion venom acts indirectly through th release of autopharmacological agents. F Abroug and colleagues4Abroug F Elatrous S Nouira S et al.Serotherapy in scorpion envenomation: a randomised controlled trial.Lancet. 1999; 354: 906-909Summary Full Text Full Text PDF PubMed Scopus (139) Google Scholar reported that scorpion antivenom was no better than placebo in Tunisia and in India, we had similar findings.3Bawaskar HS Bawaskar PH Envenoming by scorpions and snakes (elapidae), their neurotoxins and therapeutics.Trop Doct. 2000; 30: 23-25PubMed Google Scholar Prezosin is a pharmacological antidote to Mesobuthus tamulus venom actions. It lowers preload left-ventricular impedance without causing tachycardia. Prazosin reverses inotropic and hypokinetic phases evoked by scorpion envenomation.5Bawaskar HS Bawaskar PH Prazosin in management of cardiovascular manifestations of scorpion sting.Lancet. 1986; 2: 511-512Google Scholar This treatment is cheap and simple and has no risk of anaphylaxis. We trained periphaeral doctors all over Maharashtra in treatment of scorpion stings with prazosin, since then related mortality all over Maharashtra has been reduced to less than 2%.Training in appropriate use of snake antivenom and protocol of indications for its use should be arranged at general hospital level to ease the crisis of supply of antivenom. Moves to protect animal rights in India mean that chemical antidote to snake venom fractions should be sought, as we sought out prazosin, an antidote to scorpion venom actions.5Bawaskar HS Bawaskar PH Prazosin in management of cardiovascular manifestations of scorpion sting.Lancet. 1986; 2: 511-512Google ScholarWe thank S Salunke, Director of the health service of Maharashtra, for permission to study data at the general hospitals. Polyvalent snake antivenom, discussed by R Theakston and D Warrell,1Theakston RDG Warrell DA Crisis in snake antivenom supply for Africa.Lancet. 2000; 356: 2104Summary Full Text Full Text PDF PubMed Scopus (120) Google Scholar is prepared by immunisation of animals (horse, goat, sheep, &c) with snake venom. Antivenom is the only specific life-saving measure for the treatment of snake bites, but is expensive and is not free from anaphylaxis. Antivenom should, therefore, be used only in patients in whom the benefits of treatemt are judged to exceed the risk. The dose of antivenom is not fixed, but the indications are known.2Warrell DA The clinical managment of snake bites in the Southeast.Asian J Trop Med Publick Health. 1999; 30: S1-S67Google Scholar In a neuroparalysis due to elapidae envenoming, antivenom treatment alone cannot be relied upon to save life. Poisonous snakes (Bungarus caerelus, Cobra,Echis carinatus, Russell's viper), scorpion (Mesobuthus tamulus), flourish in western Maharashtra.3Bawaskar HS Bawaskar PH Envenoming by scorpions and snakes (elapidae), their neurotoxins and therapeutics.Trop Doct. 2000; 30: 23-25PubMed Google Scholar The cost of one ampoule of snake antivenom is 365 rupees (UK £5·36) and of scorpion antivenom is 242 rupees (UK £3·36), and are always in short supply. We analysed the total cases of snake bites and scorpion stings treated in 1999 (Jan-Dec) at funded general hospitals and private hospitals in the Raigad districts. Victims of snake bites and scorption stings report to general hospitals for free treatment. The medical officer frequently has never treated a case of scorpion sting or snake bite before. Much antivenom is, therefore, wasted by non-indicated use (table). Scorpion venom opens neuronal sodium channels resulting in antonomic storm, thus scorpion venom acts indirectly through th release of autopharmacological agents. F Abroug and colleagues4Abroug F Elatrous S Nouira S et al.Serotherapy in scorpion envenomation: a randomised controlled trial.Lancet. 1999; 354: 906-909Summary Full Text Full Text PDF PubMed Scopus (139) Google Scholar reported that scorpion antivenom was no better than placebo in Tunisia and in India, we had similar findings.3Bawaskar HS Bawaskar PH Envenoming by scorpions and snakes (elapidae), their neurotoxins and therapeutics.Trop Doct. 2000; 30: 23-25PubMed Google Scholar Prezosin is a pharmacological antidote to Mesobuthus tamulus venom actions. It lowers preload left-ventricular impedance without causing tachycardia. Prazosin reverses inotropic and hypokinetic phases evoked by scorpion envenomation.5Bawaskar HS Bawaskar PH Prazosin in management of cardiovascular manifestations of scorpion sting.Lancet. 1986; 2: 511-512Google Scholar This treatment is cheap and simple and has no risk of anaphylaxis. We trained periphaeral doctors all over Maharashtra in treatment of scorpion stings with prazosin, since then related mortality all over Maharashtra has been reduced to less than 2%. Training in appropriate use of snake antivenom and protocol of indications for its use should be arranged at general hospital level to ease the crisis of supply of antivenom. Moves to protect animal rights in India mean that chemical antidote to snake venom fractions should be sought, as we sought out prazosin, an antidote to scorpion venom actions.5Bawaskar HS Bawaskar PH Prazosin in management of cardiovascular manifestations of scorpion sting.Lancet. 1986; 2: 511-512Google Scholar We thank S Salunke, Director of the health service of Maharashtra, for permission to study data at the general hospitals.
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