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کاربرد نوع شرط:
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Viperidae,Snake Bites,Antivenins,Envenomation Syndrome,Species Specificity
- چکیده:
- چکیده انگلیسی: Background: Despite sharing common evolutionary features, Viperidae species including Echis carinatus and Macrovipera lebetina possess venoms with different proportions of toxic agents, thereby causing clinical effects with potentially variable severity. This study was an effort to differentiate the clinical effects and outcomes of E. c. sochureki and M. l. obtusa victims.
Methods: In this prospective cross-sectional study, snakebite patients treated at a reference poisoning center in northeast of Iran in 2012 were enrolled. The features of snakebite event, demographic and clinical data of patients were recorded in checklists.
Results: Twenty-seven patients (63% male) with mean age of 34.8 ± 18.1 years were included. The offending snakes were recorded as "E. c. sochureki" in 63%, "M. l. obtusa" in 25.9% and "unknown" in 11.1% of cases. The most common clinical findings were fang mark in 100%, local pain in 81.5% and local edema in 74% of patients. Although the victims of both species showed classic features of viper envenoming syndrome including marked local effect and hemostatic disturbances, the victims of M. l. obtusa had significantly higher creatine kinase levels (P = 0.031) and lower platelet counts (P = 0.043), whereas marked edema (> 15cm) was significantly more common in E. c. sochureki victims (P = 0.028). Envenomation severity, other clinical effects and outcomes did not differ between the two species. Patients with delayed presentation to hospital had greater envenomation severity and edema extent and higher rate of coagulopathy.
Conclusions: Species-specific description of clinical effects following snakebite envenoming is useful for syndromic approach to human victims. The clinical envenoming syndromes by E. c. sochureki and M. l. obtusa show many common similarities despite the difference in severity of some effects. The delay in hospital admission and antivenom therapy is a risk for increased severity of envenomation and development of poorer clinical outcomes.
- انتشار مقاله: 25-07-1398
- نویسندگان: Seyed Mostafa Monzavi,Reza Afshari,Ali Reza Khoshdel,Amir Ahmad Salarian,Hamid Khosrojerdi,Azam Mihandoust
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Iran,Epidemiology,Bites and Stings,Indian Ocean,Marine Toxins
- چکیده:
- چکیده انگلیسی: Background: The Persian Gulf is a suitable habitat for various types of marine species. This study was conducted with the aim of determining the epidemiology and clinical findings of injuries inflicted by marine creatures in the Persian Gulf, south Iran. Methods: In this retrospective cross-sectional study, medical records of patients with diagnosis of marine animal exposures treated at 6 referral clinics in Bushehr province, south Iran, during 2009-2014 were studied. Results: Ninety-eight patients were studied whose mean (SD, Min - Max) age was 23.6 (7.0, 14-57) years. The majority of patients (91, 92.9%) were men. Scorpionfish stings were the most common cause of injuries (56.1%) followed by jellyfish stings (22.4%), stingray stings (13.3%) and sea urchin stings (8.2%). In most cases (60.2%), the location of injury was on lower limbs. The most common symptom was pain. Marked local swelling was detected in 69.1% of scorpionfish stings and 100% of stingray stings. Itching and hives were seen in 100% and 36.3% of jellyfish stung patients. Gastrointestinal manifestations were the most common systemic effects. Muscle cramps and transient local paralysis were reported in 38.7 % and 23 % of stingray patients, respectively. Serious systemic effects were rare except for symptomatic hypotension in a scorpionfish sting patient and syncope in a stingray sting patient. The vast majority of patients (93.9%) recovered without notable sequels. Secondary dermal infections were only observed in 1 stingray inflicted victim and 4 sea urchin stung victim. No death occurred. Conclusion: Scorpionfish attacks are the common cause of marine animal exposures in south Iran and should be taken seriously. Men at young ages are the victims of this environmental and occupational hazard.
- انتشار مقاله: 26-01-1394
- نویسندگان: Iraj Nabipour,Ali Reza Khoshdel,Ali Reza Golaghaei,Ahmad Tashakori Beheshti,Reza Afshari
- مشاهده
- جایگاه : پژوهشی
- مجله: Asia Pacific Journal of Medical Toxicology
- نوع مقاله: Journal Article
- کلمات کلیدی: Snakebite,Prognostic factor,Thrombocytopenia,Therapeutic response,Initial control
- چکیده:
- چکیده انگلیسی: Background: The goal of antivenom administration for snake-bitten patients is to achieve therapeutic response (initial control), which means reversal of the venom-induced effects through neutralizing the venom. The aim of this study was to identify snakebite prognostic factors of weak therapeutic response prior to antivenom administration.
Methods: This was a retrospective study of patients with viperidae snakebite envenomation who were admitted to Mashhad Toxicology Centre during 2007-2011. Demographic features, clinical manifestations and snakebite severity score (SSS) were collected prior to antivenom administration. Total number of antivenom vials administered to achieve therapeutic response and duration of hospitalization were also recorded. Potential factors in snakebite prognosis were analyzed by comparing in two groups of achieving therapeutic response with less than 5 vials and over 5 to calculate odds ratio.
Results: Total of 108 patients (male/female: 85/23) with mean (SD) age of 34.5 (17.0) were studied. The most common manifestations included fang marks (100%), pain (100%), ecchymosis (89%), swelling (83%), blister formation (48%) and thrombocytopenia (25%). In univariate analysis, thrombocytopenia (P=0.01), spontaneous bleeding (P=0.02), coagulopathic disturbances (P=0.007), swelling (P=0.003), progressive swelling (P=0.005), ecchymosis (P=0.05) and respiratory distress (P= 0.05) were significantly correlated to weak therapeutic response. Swelling and spontaneous bleeding were the strongest snakebite prognostic factors, as respectively they put the patients at 12.4 and 10.4 fold risks for difficult achievement of therapeutic response.
Conclusions: In snakebite, some clinical manifestations in the first hours of admission and prior to antivenom administration are associated with weak therapeutic response. Identifying these prognostic factors, can assist health care providers to better estimate the patient’s needs and predict the final consequences.- انتشار مقاله: 18-06-1391
- نویسندگان: Bita Dadpour,Azam Shafahi,Seyed Mostafa Monzavi,Abbas Zavar,Reza Afshari,Ali Reza Khoshdel
- مشاهده