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Timber rattlesnake (Crotalus horridus): Biology, conservation, and envenomation in the Upper Mississippi River Valley (1982–2020) 木材响尾蛇(Crotalus horridus):密西西比河上游流域的生物学、保护和环境研究(1982-2020)
Q2 TOXICOLOGY Pub Date : 2023-09-01 DOI: 10.1016/j.toxcx.2023.100167
D.E. Keyler

The Timber Rattlesnake (Crotalus horridus) is the largest pit viper in the Northern United States and is the prominent venomous snake species indigenous to the bluff land habitats of the Upper Mississippi River Valley (UMRV). Conservation of C. horridus in this geographic region not only preserves the ecosystem's biodiversity and ecological balance, but also assures the continued study of their biomedically important venoms/toxins. Field studies of C. horridus biology and natural history performed from 1985 to 2015 in southeastern Minnesota and western Wisconsin along the Mississippi River showed populations have declined. Consequently, the implementation of improved conservation measures afforded the species protective status in both states. Historically, accounts of Timber Rattlesnake bites in the UMRV have been sparse, and medical consequences of envenomation have had limited documentation. However, in recent decades cases of envenomation by C. horridus have continued to occur. Retrospective analysis of clinical toxinology consultations documented from 1982 to 2020 on cases of envenomation by C. horridus in the UMRV revealed a very low incidence of bites annually and revealed that their venom can induce a rapid and precipitous decline in platelets.

Timber Rattlesnake(Crotalus horridus)是美国北部最大的毒蛇,也是密西西比河上游河谷(UMRV)悬崖栖息地的主要毒蛇物种。在这一地理区域保护C.horridus不仅保护了生态系统的生物多样性和生态平衡,还确保了对其生物医学上重要的毒液/毒素的持续研究。1985年至2015年,在明尼苏达州东南部和密西西比河沿岸的威斯康星州西部进行的对可怕C.horridus生物学和自然史的实地研究表明,数量有所下降。因此,改进的保护措施的实施为这两个州提供了物种保护地位。从历史上看,UMRV中关于木响尾蛇咬伤的报道很少,环境污染的医疗后果也有限。然而,近几十年来,由可怕梭菌引起的环境感染病例仍在继续发生。对1982年至2020年记录的UMRV中可怕梭菌感染病例的临床毒理学咨询的回顾性分析显示,每年被叮咬的发生率非常低,并表明它们的毒液会导致血小板迅速急剧下降。
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引用次数: 0
Considerations for the development of a field-based medical device for the administration of adjunctive therapies for snakebite envenoming 开发一种用于蛇咬环境辅助治疗的现场医疗设备的考虑因素
Q2 TOXICOLOGY Pub Date : 2023-08-19 DOI: 10.1016/j.toxcx.2023.100169
R. Marshall Werner, Allison N. Soffa

The timely administration of antivenom is the most effective method currently available to reduce the burden of snakebite envenoming (SBE), a neglected tropical disease that most often affects rural agricultural global populations. There is increasing interest in the development of adjunctive small molecule and biologic therapeutics that target the most problematic venom components to bridge the time-gap between initial SBE and the administration of antivenom. Unique combinations of these therapeutics could provide relief from the toxic effects of regional groupings of medically relevant snake species. The application a PRISMA/PICO literature search methodology demonstrated an increasing interest in the rapid administration of therapies to improve patient symptoms and outcomes after SBE. Advice from expert interviews and considerations regarding the potential routes of therapy administration, anatomical bite location, and species-specific venom delivery have provided a framework to identify ideal metrics and potential hurdles for the development of a field-based medical device that could be used immediately after SBE to deliver adjunctive therapies. The use of subcutaneous (SC) or intramuscular (IM) injection were identified as potential routes of administration of both small molecule and biologic therapies. The development of a field-based medical device for the delivery of adjunctive SBE therapies presents unique challenges that will require a collaborative and transdisciplinary approach to be successful.

及时服用抗蛇毒血清是目前减轻蛇咬伤中毒负担的最有效方法,蛇咬伤是一种被忽视的热带疾病,最常影响全球农村农业人口。人们对开发针对最有问题的毒液成分的辅助小分子和生物疗法越来越感兴趣,以弥补初始SBE和抗蛇毒血清给药之间的时间差距。这些疗法的独特组合可以减轻医学相关蛇种区域分组的毒性影响。PRISMA/PICO文献检索方法的应用表明,人们对快速给予治疗以改善SBE后患者症状和结果越来越感兴趣。专家访谈的建议和关于潜在治疗给药途径、解剖咬合位置和物种特异性毒液递送的考虑,为开发可在SBE后立即用于提供辅助治疗的现场医疗设备提供了一个框架,以确定理想的指标和潜在障碍。皮下(SC)或肌肉内(IM)注射被确定为小分子和生物疗法的潜在给药途径。用于辅助SBE治疗的现场医疗设备的开发提出了独特的挑战,需要合作和跨学科的方法才能取得成功。
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引用次数: 0
Neurologic and hematologic sequalae following a timber rattlesnake (Crotalus horridus) envenomation in a dachshund 达克斯犬木材响尾蛇(Crotalus horridus)中毒后的神经和血液学研究
Q2 TOXICOLOGY Pub Date : 2023-06-01 DOI: 10.1016/j.toxcx.2023.100156
Cory Woliver , Michael Schaer

A 2-year-old female Dachshund had a witnessed timber rattlesnake envenomation. Although rattlesnake envenomations are a common, potentially life-threatening event in companion animals, timber rattlesnake envenomations in the dog are rarely reported. This dog described in this case report had significant hematologic and neurologic clinical derangements consistent with Types A and B rattlesnake venom and a suspected hypersensitivity reaction to the venom. This patient was treated aggressively with antivenom and fully recovered without any persistent neurologic signs at follow-up.

一只2岁的雌性腊肠犬目睹了木材响尾蛇的灭绝。尽管响尾蛇中毒在伴侣动物中是一种常见的、可能危及生命的事件,但在狗身上发生木材响尾蛇感染的报道很少。本病例报告中描述的这只狗有明显的血液学和神经临床紊乱,与A型和B型响尾蛇毒液一致,并怀疑对毒液有超敏反应。该患者接受了抗蛇毒血清的积极治疗,并在随访中完全康复,没有任何持续的神经系统症状。
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引用次数: 0
A subfraction obtained from the venom of the tarantula Poecilotheria regalis contains inhibitor cystine knot peptides and induces relaxation of rat aorta by inhibiting L-type voltage-gated calcium channels 从狼蛛毒液中获得的一个亚组分含有抑制剂胱氨酸结肽,并通过抑制L型电压门控钙通道诱导大鼠主动脉舒张
Q2 TOXICOLOGY Pub Date : 2023-06-01 DOI: 10.1016/j.toxcx.2023.100151
Luis Fernando Díaz-Peña , Torres-Ortiz Daniela , Manuel B. Aguilar , Enoch Luis , Fernando Lazcano-Pérez , Roberto Arreguín-Espinosa , Arturo Hernandez-Cruz , César Ibarra-Alvarado , Alejandro García-Arredondo

Venoms from tarantulas contain low molecular weight vasodilatory compounds whose biological action is conceived as part of the envenomation strategy due to its propagative effects. However, some properties of venom-induced vasodilation do not match those described by such compounds, suggesting that other toxins may cooperate with these ones to produce the observed biological effect. Owing to the distribution and function of voltage-gated ion channels in blood vessels, disulfide-rich peptides isolated from venoms of tarantulas could be conceived into potential vasodilatory compounds. However, only two peptides isolated from spider venoms have been investigated so far. This study describes for the first time a subfraction containing inhibitor cystine knot peptides, PrFr-I, obtained from the venom of the tarantula Poecilotheria regalis. This subfraction induced sustained vasodilation in rat aortic rings independent of vascular endothelium and endothelial ion channels. Furthermore, PrFr-I decreased calcium-induced contraction of rat aortic segments and reduced extracellular calcium influx to chromaffin cells by the blockade of L-type voltage-gated calcium channels. This mechanism was unrelated to the activation of potassium channels from vascular smooth muscle, since vasodilation was not affected in the presence of TEA, and PrFr-I did not modify the conductance of the voltage-gated potassium channel Kv10.1. This work proposes a new envenomating function of peptides from venoms of tarantulas, and establishes a new mechanism for venom-induced vasodilation.

狼蛛的毒液含有低分子量的血管舒张化合物,由于其繁殖作用,其生物作用被认为是环境形成策略的一部分。然而,毒液诱导的血管舒张的一些特性与这些化合物所描述的特性不匹配,这表明其他毒素可能与这些毒素合作产生观察到的生物效应。由于电压门控离子通道在血管中的分布和功能,从狼蛛毒液中分离出的富含二硫化物的肽可以被认为是潜在的血管舒张化合物。然而,到目前为止,只有两种从蜘蛛毒液中分离的肽被研究过。本研究首次描述了从狼蛛毒液中获得的含有抑制剂胱氨酸结肽PrFr-I的亚组分。该亚组分在不依赖于血管内皮和内皮离子通道的大鼠主动脉环中诱导持续的血管舒张。此外,PrFr-I通过阻断L型电压门控钙通道,减少了钙诱导的大鼠主动脉段收缩,并减少了细胞外钙流入嗜铬细胞。该机制与血管平滑肌钾通道的激活无关,因为在TEA存在的情况下血管舒张不受影响,并且PrFr-I不会改变电压门控钾通道Kv10.1的电导。这项工作提出了狼蛛毒液肽的一种新的环境交配功能,并建立了毒液诱导血管舒张的新机制。
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引用次数: 1
The safety of botulinum neurotoxin type A's intraarticular application in experimental animals A型肉毒杆菌神经毒素在实验动物关节内应用的安全性
Q2 TOXICOLOGY Pub Date : 2023-06-01 DOI: 10.1016/j.toxcx.2023.100155
Ana Dugonjić Okroša , Victor Ricardo Manuel Muñoz-Lora , Ivica Matak , Lidija Bach-Rojecky , Mikhail Kalinichev , Zdravko Lacković

In vivo studies of botulinum neurotoxin type A (BoNT-A) enabled characterization of its activity in the nociceptive sensory system separate from its preferred action in motor and autonomic nerve terminals. However, in the recent rodent studies of arthritic pain which employed high intra-articular (i.a.) doses (expressed as a total number of units (U) per animal or U/kg), possible systemic effects have not been conclusively excluded. Herein we assessed the effect of two pharmaceutical preparations, abobotulinumtoxinA (aboBoNT-A, 10, 20, and 40 U/kg corresponding to 0.05, 0.11, and 0.22 ng/kg neurotoxin) and onabotulinumtoxinA (onaBoNT-A, 10 and 20 U/kg corresponding to 0.09 and 0.18 ng/kg, respectively) injected into the rat knee, on safety-relevant readouts: digit abduction, motor performance and weight gain during 14 days post-treatment.

The i. a. toxin produced dose-dependent impairment of the toe spreading reflex and rotarod performance, which was moderate and transient after 10 U/kg onaBoNT-A and ≤20 U/kg aboBoNT-A doses, and severe and long-lasting (examined up to 14 days) after ≥20 U/kg of onaBoNT-A and 40 U/kg aboBoNT-A. In addition, lower toxin doses prevented the normal weight gain compared to controls, while higher doses induced marked weight loss (≥20 U/kg of onaBoNT-A and 40 U/kg aboBoNT-A).

Commonly employed BoNT-A formulations, depending on the doses, cause local relaxation of the surrounding muscles and systemic adverse effects in rats. Thus, to evade possible toxin unwanted local or systemic spread, careful dosing and motor testing should be mandatory in preclinical behavioral studies, irrespective of the sites and doses of toxin application.

A型肉毒杆菌神经毒素(BoNT-A)的体内研究使其能够表征其在伤害性感觉系统中的活性,而不是其在运动和自主神经末梢中的首选作用。然而,在最近对关节炎疼痛进行的啮齿类动物研究中,使用了高关节内(i.a.)剂量(以每只动物的单位总数或U/kg表示),尚未最终排除可能的全身影响。在本文中,我们评估了注射到大鼠膝盖中的两种药物制剂,abobotulinumtoxinA(aboBoNT-A,10,20和40U/kg,对应于0.05,0.11和0.22纳克/公斤神经毒素)和onabotulinumtoxinA(onaBoNT-A、10和20U/kg,分别对应于0.09和0.18纳克/千克)对安全相关读数的影响:手指外展,运动性能和治疗后14天的体重增加。i.a.毒素对脚趾伸展反射和旋转杆性能产生剂量依赖性损伤,在10 U/kg onaBoNT-a和≤20 U/kg aboBoNT-a剂量后为中度和短暂性损伤,而在≥20 U/kg onaBoNT-a和40 U/kg aboBoNT-a剂量时为严重和持久性损伤(检查长达14天)。此外,与对照组相比,较低的毒素剂量阻止了正常的体重增加,而较高的剂量诱导了显著的体重减轻(≥20 U/kg的onaBoNT-A和40 U/kg的aboBoNT-A)。根据剂量的不同,常用的BoNT-A制剂会导致大鼠周围肌肉的局部松弛和全身不良反应。因此,为了避免毒素可能不必要的局部或系统传播,在临床前行为研究中,无论毒素应用的地点和剂量如何,都必须仔细给药和运动测试。
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引用次数: 0
Availability, accessibility and use of antivenom for snakebite envenomation in Africa with proposed strategies to overcome the limitations 抗蛇毒血清在非洲的可用性、可及性和使用情况,以及克服限制的拟议策略
Q2 TOXICOLOGY Pub Date : 2023-06-01 DOI: 10.1016/j.toxcx.2023.100152
Mahmood Muazu Dalhat , Julien Potet , Abdulaziz Mohammed , Nafiisah Chotun , Hanna Amanuel Tesfahunei , Abdulrazaq Garba Habib

Africa remains one of the regions with the highest incident and burden of snakebite. The goal of the World Health Organization to halve the global burden of snakebite by 2030 can only be achieved if sub-optimal access to antivenoms in the most affected regions is addressed. We identified upstream, midstream, and downstream factors along the antivenom value chain that prevent access to antivenoms in the African region. We identified windows of opportunities that could be utilized to ensure availability, accessibility, and affordability for snakebite endemic populations in Africa. These include implementation of multicomponent strategies such as intensified advocacy, community engagement, healthcare worker trainings, and leveraging the institutional and governance structure provided by African governments to address the challenges identified.

非洲仍然是毒蛇咬伤事件和负担最高的地区之一。只有解决受影响最严重地区获得抗蛇毒血清的次优途径问题,世界卫生组织到2030年将全球毒蛇咬伤负担减半的目标才能实现。我们确定了抗蛇毒血清价值链上阻碍非洲地区获得抗蛇毒血清的上游、中游和下游因素。我们确定了可用于确保非洲蛇咬伤流行人群的可用性、可及性和可负担性的机会窗口。其中包括实施多要素战略,如加强宣传、社区参与、医护人员培训,以及利用非洲政府提供的体制和治理结构来应对已确定的挑战。
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引用次数: 2
Clinical effects of immunization, bleeding, and albumin-based fluid therapy in horses used as immunoglobulin source to produce a polyspecific antivenom (Echitab-plus-ICP) towards venoms of African snakes 免疫、出血和白蛋白液体疗法在马身上的临床效果用作免疫球蛋白来源,以产生针对非洲蛇毒液的多特异性抗蛇毒血清(Echitab加ICP)
Q2 TOXICOLOGY Pub Date : 2023-06-01 DOI: 10.1016/j.toxcx.2023.100158
Rose Mary Huertas , Mauricio Arguedas , Juan Manuel Estrada , Edwin Moscoso , Deibid Umaña , Gabriela Solano , Mariángela Vargas , Álvaro Segura , Andrés Sánchez , María Herrera , Mauren Villalta , Cynthia Arroyo-Portilla , José María Gutiérrez , Guillermo León

During the production of snake antivenoms, the animals used as immunoglobulin source are subjected to processes that could deteriorate their physical condition. Therefore, these conditions must be carefully designed and validated. In this work, the immunization and bleeding protocols applied to horses used to produce the African polyspecific antivenom EchiTAb-plus-ICP were evaluated regarding their effects on the horses' health. The study focused on horses that had been previously immunized with venoms and then received periodic booster venom injections for antivenom production. It was found that the periodic immunization with 5 mg of a mixture of venoms of Bitis arietans, Echis ocellatus, Dendroaspis polylepis, and Naja nigricollis did not induce systemic signs of envenomation, and only caused mild swelling at the injection site, which did not evolve to abscesses, fistulas, or fibrosis. Three consecutive days of bleeding, collecting 6–8 L of blood per day, and self-transfusing the red blood cells (RBC) in the second and third days, did not induce evident cardiorespiratory alterations. However, this procedure caused significant reductions in RBC, hematocrit, hemoglobin, and total plasma protein values. Seven weeks after bleeding, these parameters were recovered, and horses were ready for the next immunization/bleeding cycle. The intravenous administration of equine albumin, at a dose of 2 g/kg body weight, increased the apparent plasma volume and the albumin concentration. However, this procedure induced early adverse reactions and transient alterations of the serum levels of the enzyme gamma-glutamyl transferase (GGT), thus suggesting some degree of hepatic injury. It was concluded that immunization and bleeding as described in this work do not cause significant clinical alterations in the horse's health, except for a transient drop in some hematological parameters. The albumin-based fluid therapy used does not hasten the recovery after bleeding but instead induces adverse events in the animals.

在蛇抗蛇毒血清的生产过程中,用作免疫球蛋白来源的动物会经历可能恶化其身体状况的过程。因此,必须仔细设计和验证这些条件。在这项工作中,评估了用于生产非洲多特异性抗蛇毒血清EchiTAb加ICP的马的免疫和出血方案对马健康的影响。这项研究的重点是之前用毒液免疫过的马,然后定期注射加强针以生产抗蛇毒血清。研究发现,用5 mg的Bitis arietans、Echis ocellatus、Dendroaspis polylepis和Naja nigricolis的静脉混合物进行周期性免疫,不会引起系统性的envenomation迹象,只会在注射部位引起轻度肿胀,不会发展成脓肿、瘘管或纤维化。连续三天出血,每天采集6-8升血液,并在第二天和第三天自行输注红细胞,没有引起明显的心肺功能改变。然而,该程序导致红细胞、红细胞比容、血红蛋白和总血浆蛋白值显著降低。出血七周后,这些参数得到恢复,马匹为下一个免疫/出血周期做好了准备。以2g/kg体重的剂量静脉注射马白蛋白,增加了表观血浆体积和白蛋白浓度。然而,这一过程导致了早期不良反应和血清γ-谷氨酰转移酶(GGT)水平的短暂变化,从而表明存在一定程度的肝损伤。得出的结论是,这项工作中描述的免疫和出血不会对马的健康造成显著的临床变化,除了一些血液学参数的短暂下降。所使用的基于白蛋白的液体疗法并不能加速出血后的恢复,反而会在动物中引发不良事件。
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引用次数: 0
Special issue editorial: Resource mapping for the management of snakebite envenomation 特刊社论:蛇咬环境管理的资源测绘
Q2 TOXICOLOGY Pub Date : 2023-06-01 DOI: 10.1016/j.toxcx.2023.100154
Wuelton M. Monteiro , Hui Wen Fan , Abdulrazaq G. Habib , Kalana Maduwage , João Ricardo Nickenig Vissoci , José María Gutiérrez
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引用次数: 0
Snakebite care through the first two waves of COVID-19 in West Bengal, India: a qualitative study 印度西孟加拉邦前两波新冠肺炎期间的蛇咬伤护理:一项定性研究
Q2 TOXICOLOGY Pub Date : 2023-06-01 DOI: 10.1016/j.toxcx.2023.100157
Soumyadeep Bhaumik , Deepti Beri , Anthony B. Zwi , Jagnoor Jagnoor

Snakebite is a public health problem in many countries, with India having the highest number of deaths. Not much is known about the effect of the COVID-19 pandemic on snakebite care. We conducted 20 in-depth interviews with those bitten by venomous snakes through the two waves of COVID-19 (March–May 2020; May–November 2021), their caregivers, health care workers and social workers in two areas (Sundarbans and Hooghly) of West Bengal, India. We used a constructivist approach and conducted a thematic analysis. We identified the following themes: 1. Snakebite continued to be recognised as an acute emergency during successive waves of COVID-19; 2. COVID-19 magnified the financial woes of communities with high snakebite burden; 3. The choice of health care provider was driven by multiple factors and consideration of trade-offs, many of which leaned toward use of traditional providers during COVID-19; 4. Rurality, financial and social disadvantage and cultural safety, in and beyond the health system, affected snakebite care; 5. There is strong and shared felt need for multi-faceted community programs on snakebite.

We mapped factors affecting snakebite care in the three-delay model (decision to seek care, reaching appropriate health facility, receiving appropriate care), originally developed for maternal mortality. The result of our study contextualises and brings forth evidence on impact of COVID-19 on snakebite care in West Bengal, India. Multi-faceted community programs, are needed for addressing factors affecting snakebite care, including during disease outbreaks - thus improving health systems resilience. Community programs for increasing formal health service usage, should be accompanied by health systems strengthening, instead of an exclusive focus on awareness against traditional providers.

蛇咬伤是许多国家的公共卫生问题,其中印度的死亡人数最多。关于新冠肺炎大流行对蛇咬伤护理的影响,目前尚不清楚。我们在印度西孟加拉邦的两个地区(Sundarbans和Hooghly)对新冠肺炎两波疫情期间(2020年3月至5月;2021年5月至11月)被毒蛇咬伤的人、他们的护理人员、医护人员和社会工作者进行了20次深入采访。我们采用了建构主义的方法,并进行了专题分析。我们确定了以下主题:1。在连续几波新冠肺炎疫情期间,蛇咬伤继续被视为一种急性紧急情况;2.新冠肺炎加剧了高蛇咬伤负担社区的财务困境;3.医疗保健提供者的选择是由多种因素和权衡因素驱动的,其中许多因素倾向于在新冠肺炎期间使用传统提供者;4.卫生系统内外的不道德、经济和社会劣势以及文化安全影响了蛇咬伤护理;5.关于蛇咬伤的多方面社区项目有着强烈而共同的需求。我们在三延迟模型中绘制了影响蛇咬伤护理的因素(决定寻求护理、到达适当的卫生机构、接受适当的护理),该模型最初是为孕产妇死亡率开发的。我们的研究结果结合新冠肺炎对印度西孟加拉邦蛇咬伤护理的影响并提供了证据。需要多方面的社区计划来解决影响蛇咬伤护理的因素,包括在疾病爆发期间,从而提高卫生系统的复原力。增加正规医疗服务使用的社区计划应与加强卫生系统相结合,而不是只关注对传统提供者的认识。
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引用次数: 0
Snakebite envenoming at MSF: A decade of clinical challenges and antivenom access issues 无国界医生的蛇咬伤环境:十年的临床挑战和抗蛇毒血清获取问题
Q2 TOXICOLOGY Pub Date : 2023-03-01 DOI: 10.1016/j.toxcx.2022.100146
Julien Potet , Saschveen Singh , Koert Ritmeijer , Kasaye Sisay , Gabriel Alcoba , Fabienne Jouberton , Yannick Wilson Henko Kinding , Alexandra Kruse , Aboubacar Bengaly , Malwal Sabino , Narcisse Patrice Komas , Matthew Coldiron

The medical humanitarian organization Médecins Sans Frontières (MSF) provides medical care in more than 70 countries and admits more than 7000 cases of snakebite in its facilities each year.

We describe our activities against snakebite in three African countries: Central African Republic, South Sudan and Ethiopia, in which different models of care have been developed. A standard protocol using two different antivenoms depending on the patient's syndrome has been introduced, and a simple blood coagulation test is performed to detect venom-induced coagulopathy. Other services, including surgery for necrotizing wounds, are offered in the facilities where MSF admits a large number of snakebite patients. All services, including provision of antivenom, are offered free-of-charge in MSF-supported facilities. Community-based activities focusing on preventive measures and prompt transport to hospital have been developed in a few MSF projects.

The provision of quality care and treatment, including effective antivenoms, without out-of-pocket payments by the patients, probably explains why MSF has admitted an increasing number of snakebite victims over the last years. This model requires significant resources and monitoring, including regular training of healthcare workers on treatment protocols and a considerable budget for antivenom procurement.

医疗人道主义组织无国界医生组织(MSF)在70多个国家提供医疗服务,每年在其设施中收治7000多例蛇咬伤病例。我们介绍了我们在中非共和国、南苏丹和埃塞俄比亚这三个非洲国家开展的反蛇咬活动,这些国家已经制定了不同的护理模式。根据患者的综合征,引入了使用两种不同抗蛇毒血清的标准方案,并进行了简单的凝血测试来检测毒液诱导的凝血病。其他服务,包括坏死性伤口的手术,也在无国界医生接纳大量蛇咬伤患者的设施中提供。所有服务,包括提供抗蛇毒血清,都在无国界医生支持的设施中免费提供。无国界医生组织的一些项目开展了以社区为基础的活动,重点是预防措施和及时送往医院。提供高质量的护理和治疗,包括有效的抗蛇毒血清,而患者无需自付费用,这可能解释了为什么无国界医生在过去几年里接纳了越来越多的蛇咬伤受害者。这种模式需要大量的资源和监测,包括对医护人员进行治疗方案的定期培训,以及采购抗蛇毒血清的可观预算。
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引用次数: 2
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