Transactions of The Royal Society of Tropical Medicine and Hygiene最新文献

Snakebite envenomation continues to affect lives globally, with >1.2 million envenomations and approximately 120 000 annual mortalities. Unfortunately, low- and middle-income countries (LMICs) contribute to >80% of these global statistics. With different targets set to minimize the impact of snakebite envenoming, such as halving the envenoming cases by 2030 from the World Health Organization (WHO), multiple initiatives are inevitable. Gender intersectionality and tropical disease research for infectious diseases of poverty, developed by the WHO, has championed the exploration of neglected diseases, stratifying them using gendered domains. However, minimal research using the gender intersectionality framework has been conducted to explore snakebite envenoming, especially among LMICs. Exploring snakebite envenomation through a gendered lens is critical in developing gender-specific interventions for the prevention and treatment of envenomation. This narrative review explores the available literature about snakebite envenomation in LMICs through a gender intersectionality lens. It provides insights into the existing gaps, especially regarding research using intersectionality frameworks and the gendered matrix. It further proposes avenues of research using these domains to understand snakebite envenomation, especially through the intersectionality lens.

Background: Evidence has shown that the incidence of bacillary dysentery (BD) is associated with climatic factors. However, the lagged effects of climatic factors on BD are still unclear, especially lacking research evidence from arid and semi-arid regions. Therefore, this study aims to add new insights into this research field.

Methods: Spatial autocorrelation, time series analysis and spatiotemporal scans were used to perform descriptive analyses of BD cases from 2009 to 2019. On the basis of monthly data from 2015 to 2019, multivariable distributed lag non-linear models were used to investigate the lagged effects of climatic factors on BD.

Results: The hot spots for BD incidence are gradually decreasing and becoming increasingly concentrated in the southern part of Gansu Province. The maximum cumulative relative risks for monthly average temperature, sunshine duration, average relative humidity and precipitation were 3.21, 1.64, 1.55 and 1.41, respectively. The lagged effects peaked either in the current month or with a 1-month lag, and the shape of the exposure-response curve changed with the increase in maximum lag time. After stratification by per capita gross domestic product, there were differences in the effects.

Conclusions: Climatic factors can influence the incidence of BD, with effects varying across different lag times. It is imperative to vigilantly track the disparities in the incidence of BD attributable to economic factors.

Background: This study aimed to characterise the clinical and epidemiological profiles of dengue patients and their outcomes during an ongoing outbreak in a non-endemic region of Bangladesh.

Methods: This prospective observational study analysed 805 confirmed dengue cases during August-December 2023. Data on demographic, clinical and laboratory profiles, as well as outcomes, were gathered using a structured questionnaire. Statistical analysis was conducted using SPSS 25.

Results: The mean age of dengue patients was 31.5 (±12.2) y, with the majority being males (81.2%). All 805 patients experienced fever, 792 (98.4%) had headaches, 698 (86.7%) had myalgia, 601 (74.7%) had persistent vomiting and 598 (74.3%) had abdominal pain. Bleeding was observed in 191 (23.7%) patients and neurological symptoms were seen in 209 (25.9%) patients. Most patients (n=781, 97%) exhibited non-severe symptoms, while 3% (n=24) had severe symptoms. Among the 24 severe cases, four (16.7%) patients were reported to have encephalitis and one (4.2%) patient had meningoencephalitis. Moreover, 365 patients (45.3%) had travelled to an endemic region who were predominantly males (n=327, 89.6%). Most dengue patients recovered well with rapid fluid replacement therapy (n=754, 93.7%).

Conclusions: The 2023 dengue outbreak in a non-endemic area of Bangladesh primarily impacted males, young adults, with the majority presenting non-severe symptoms. Further studies are essential to validate and build upon these results.

Envenomations caused by viperid and some elapid snakebites are typically accompanied by local swelling and signs of inflammation that appear within a few hours of bite and spread centripetally for a few days. Often these changes are mistaken for signs of infection and are misdiagnosed as 'cellulitis'. This potentially results in unwarranted use of antibiotics. There are important clinical differences between the swelling caused by local envenomation vis-à-vis cellulitis. The term venom-induced spreading sterile inflammation (VISSI) is more appropriate as a diagnosis name for the local swelling caused by snakebite envenomation.

Snakebite-associated acute kidney injury (AKI) poses a significant health burden in the South Asia region, resulting in considerable morbidity and mortality. Multiple factors contribute to the pathogenesis of AKI following snakebites, including hypotension, intravascular haemolysis, disseminated intravascular coagulation, rhabdomyolysis, thrombotic microangiopathy (TMA) and direct nephrotoxicity. Clinical features manifest as anuria, oliguria, haematuria, abdominal pain and hypertension. Diagnosis is supported by elevated serum creatinine levels and urine output monitoring. Renal histology studies revealed a spectrum of lesions, including acute tubular necrosis, renal cortical necrosis, glomerulonephritis and TMA. Management strategies centre around timely administration of antivenom, fluid and electrolyte balance and dialysis to improve renal outcomes. While dialysis has demonstrated efficacy in reducing AKI-related mortality rates, the use of fresh frozen plasma and therapeutic plasma exchange may be the subject of some controversy. Understanding the pathophysiological link between coagulopathy, TMA and AKI is important for tailoring effective treatment approaches. Species-specific randomized controlled trials are imperative to evaluate targeted interventions. In tackling the complexities of snakebite-associated AKI and chronic kidney disease, a multidisciplinary approach integrating clinical management with rigorous research efforts is essential. This collaborative endeavour aims to confront the challenges posed by these conditions and improve patient outcomes in the affected regions.

Snake venom proteins have long been recognized for their therapeutic potential. Proteogenomic strategies, integrating transcriptomics and proteomics, have emerged as powerful tools for identifying and characterizing venom proteins for the development of novel therapeutic agents. Analytical techniques like mass spectrometry and next-generation sequencing enable comprehensive analysis, identifying key venom components and their variants. Recent studies unveil the diversity and complexity of snake venom, highlighting species-specific variations in toxin composition. Structural biology techniques, including x-ray crystallography and cryo-electron microscopy, provide insights into venom enzyme structures and mechanisms of action, facilitating drug design. Bioinformatics tools aid in data analysis and prediction of venom protein functions, enhancing drug discovery efforts. Despite advancements, challenges persist, including toxicity, formulation stability and clinical validation. This review describes the current as well as future options for research and development and emphasizes the critical role of proteogenomic techniques in developing snake venom protein-based drugs.

Background: Little is known about snakebites by Naja samarensis, a species unique to the Philippines. The aim here is to describe the clinical and epidemiological characteristics of patients bitten by this medically important cobra in the Eastern Visayas.

Methods: A hospital-based prospective study analysed the features of snakebite patients attending Eastern Visayas Medical Center between June 2022 and May 2023. Logistic regression analysis identified the factors associated with severity.

Results: A total of 175 snakebite patients with five fatalities were included. Naja samarensis was most commonly implicated (n=49, 28.0%), although it could be definitively identified, by examining photographs of the snake responsible, in only four cases. The N. samarensis bites occurred in grass or rice fields, in daytime, and during farming activities, but the people bitten were most frequently students (34.7%) who were bitten at home (36.7%). Patients bitten by N. samarensis often presented with cytotoxic (63.3%) and neurotoxic signs (46.9%). Traditional remedies were common, resulting in delayed presentation to the hospital. Bites by N. samarensis, and older age (>44 y) were independently associated with severity (adjusted OR of 10.33 and 7.89, respectively).

Conclusion: Naja samarensis is a major cause of severe snakebites in this region. Pre-hospital treatment frequently involves wasted time and unproven traditional methods. Enhancement of public awareness is urgently needed. Development of a diagnostic test for species identification is warranted to improve future surveys and management.

Background: Despite the availability of antivenom, not all snakebite victims choose to seek allopathic care. This choice of care is likely to be determined by unexplored personal and external factors. We studied the factors influencing the choice of treatment and first aid measures among snakebite victims.

Methods: We conducted a population-based study integrating quantitative and qualitative research methods among snakebite victims in the preceding 12 months, selected from 8707 residents in Ampara District, representing typical rural Sri Lanka with a high snakebite burden. Interviewers collected data using questionnaires and in-depth interviews. Logistic regression and thematic analysis were performed.

Results: Among the 153 victims, 57.5% were farmers. As first aid, 19.6% practiced the application of tourniquets. The treatment choices were allopathic medicine (65.4%), ayurvedic/traditional (26.1%), faith healing (3.3%), self-medication (2.0%) and none (3.3%). Visible ambient light at the time of bite (adjusted odds ratio [aOR] 2.3 [95% confidence interval {CI} 1.1 to 4.7]), absence of local swelling (aOR 2.5 [95% CI 1.1 to 5.3]) and prolonged bleeding (aOR 8.6 [95% CI 1.9 to 33.3]) determined failure to seek allopathic treatment, while personal characteristics showed no influence. Qualitative inquiry revealed that the treatment choice was influenced by the ability of the victim or others to recognize envenoming features and the snake as venomous and awareness of the facilities available in hospitals.

Conclusions: The time of snakebite, recognition of the snake/envenoming and awareness of accessible medical services determined the treatment choice following snakebite.

Background: Measuring satisfaction with health service delivery in fragile communities provides an opportunity to improve the resilience of health systems to threats including climate change. Additionally, understanding factors associated with the choice of response strategies to certain public health threats provides an opportunity to design context-specific interventions.

Methods: We used polytomous latent class analyses to group participants' responses and an additive Bayesian modelling network to explore satisfaction with health service delivery as well as factors associated with response strategies of households to malaria. We did this with a focus on the rural parts of Uganda in Mount Elgon.

Results: We found that approaches to malaria control and management at household level include the use of traditional (54.5%), private (20.5%) and publicly available services (25%). Regarding satisfaction with health services, 66.6% of respondents were satisfied with health service components of information flow, drug/vaccine access and accessibility. Type of housing, livelihood sources, previous malaria experience and health services were strongly associated with responses to malaria occurrence at household level. The rest of the factors were weakly associated with malaria responses.

Conclusions: The indigenous interventions utilised by households to manage and control malaria were largely dependent on their satisfaction with health service delivery components. Interventions thus ought to leverage local existing knowledge to optimise outcomes and ensure sustainable health.