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Snakebite envenomings (SBEs) and other envenomings triggered by venomous animals (VAEs) represent a significant disease burden in Brazil, with 29,152 SBEs reported in 2021 alone with nearly half of those occurring in the remote Brazilian Amazon. In 2021, Brazil recorded 240,294 envenomings from snakes, scorpions, spiders, and caterpillars. Therefore, there is an unequal distribution of SBEs with high morbidity and mortality in the Brazilian Amazon. The severity of SBEs increases when patients require more than 6 h to access antivenom treatment, a common issue for the rural and indigenous populations. Understanding currently available resources and practices in Amazon remote areas of Brazil can serve to inform future interventions and guide health care policies. This study aims to develop a resource map of existing healthcare resources for the Brazilian Amazon's clinical management of VAEs with emphasis in SBEs, which will aid future strategic interventions. Data collection included a literature review, secondary data collected by government departments and organizational records, GIS mapping activities, and expert input. Our framework was guided by the three levels of healthcare service ecosystem analysis (macro, meso, and micro). Our resource map lays out a comprehensive overview of antivenom access, the distribution landscape, differences in patient transportation, and barriers to access healthcare that face populations in the Brazilian Amazon.

Snakebite envenoming is an acute medical emergency which affects hundreds of thousands of people worldwide, primarily in remote rural areas of low-and middle income countries in the Global South. A considerable proportion of snakebite patients turn to traditional healers (THs) for help, driven by a number of push and pull factors. These include socio-cultural factors, geographical proximity, and the absence or inaccessibility of overstretched and often costly allopathic healthcare services. Although traditional healers and allopathic healthcare staff share a common focus -the recovery and well-being of their patients- both systems operate largely in parallel to each other with collaborations being an exception rather than the rule. This is to the detriment of snakebite patients, who frequently find themselves being caught-up in the dualism between the two separate systems. Given the right circumstances, snakebite patients could benefit from elements of care from both modalities. Here, we have reviewed the role of THs in snakebite care and explored how their integration into the formal healthcare system could improve the implementation and outcome of care. The effective recruitment of THs to aid in disease control and treatment efforts in diseases other than snakebite underscores the potential benefits of this strategy. Carefully devised proof of concept studies are needed to test our hypothesis that collaborations between the formal healthcare sector and THs are feasible and improve outcomes in snakebite care.

Snakebite envenoming (SBE) is a common neglected tropical disease in rural communities of Asia, Africa and Latin America. Among the several challenges besetting the control of SBE is inadequate access to high-quality care by snakebite victims, partly contributed by inadequate knowledge of SBE among healthcare professionals (HCPs). This narrative review examined the existing literature on the knowledge of snakebites among HCPs, the factors associated with their knowledge of snakebites and their training needs. Data on the knowledge of healthcare professionals regarding snakebites appeared scanty and were predominantly from studies done in Asia, Africa, and the Middle East. We found that the proportion of health workers with adequate knowledge of local medically important snakes could be as low as 20.2% in some settings in India, while as much as three-quarters of health workers still recommend tourniquets and Blackstone as first aid in some settings in India and Rwanda, respectively. In addition, the mean knowledge score of local snake-induced clinical syndromes could be as low as 46.2% in some settings in Ghana, while 52.7% of tertiary hospital doctors in northern Nigeria recommend antivenom in all snakebite cases. Similarly, 23% of Bhutan health workers have adequate overall knowledge of snakebite management. Furthermore, several sociodemographic characteristics of the HCPs (such as increasing age, years of experience, work setting, medical specialty, health profession and previous involvement in snakebite management) are associated with adequate snakebite knowledge. Moreover, most studies have consistently reported a lack of training on snakebites as a challenge. Therefore, the knowledge gaps identified could be incorporated into training programs and regional policies on SBE treatment protocols.

Availability and accessibility of safe and effective antivenoms are key elements for the successful treatment of snakebite envenoming (SBE). This study provides a preliminary analysis on the way antivenoms are managed by the public health system in Costa Rica and on the role played by pharmacists in the overall management of antivenoms. This was an observational, cross-sectional study based on an online survey sent to pharmacists working at Caja Costarricense de Seguro Social (Costa Rican Social Security System; CCSS) in different locations in Costa Rica. Characteristics and location of health facilities, as well as antivenom availability and management details, were analyzed. Responses from a total of 96 pharmacists, corresponding to 55 different healthcare facilities, were included in this study. Most respondents worked at pharmacies located in urban communities (69.0%) and in the secondary level of care, which includes clinics, and regional and peripheral hospitals (55.2%). Overall, participants reported antivenom availability at all levels of care and in centers having various operating schedules, although they were not available in some facilities in regions where SBE is uncommon or do not attend SBE cases because of the proximity of more complex health centers. On average, the stocks of anticoral and polyvalent antivenoms per health facility were compatible with the dose of antivenom required for treating a SBE case. More than half of participants reported knowing the availability of protocols for the management of SBE and the correct use of antivenom at their healthcare facilities. Of the total respondents, 49% agreed on possessing all the resources needed for the correct management of these medicines at their facilities, and 65.6% indicated that they know the procedures for antivenom storage and management. Our findings provide a first description of the availability of antivenoms in the public health system of Costa Rica, including the primary care level. Results also underscore the perceived role of participating pharmacists in the management of these life-saving drugs and the need to improve their knowledge on this topic.

Maize is a staple food in Kenya. However, maize is prone to fungal infestation, which may result in production of harmful aflatoxins and fumonisins. Electron beam (eBeam) food processing is a proven post-harvest technology, but published literature is rare on the ability of eBeam to reduce mycotoxins in naturally contaminated maize samples. This study evaluated the efficacy of eBeam doses in reducing viable fungal populations and the destruction of aflatoxins and fumonisins in naturally highly contaminated maize samples from eastern Kenya. Ninety-seven maize samples were analyzed for total aflatoxins and fumonisins using commercial ELISA kits. Then, 24 samples with >100 ng/g of total aflatoxins and >1000 ng/g of total fumonisins were chosen for eBeam toxin degradation studies. Prior to eBeam exposure studies, the samples were made into a slurry using sterile de-ionized water. These slurry samples were exposed to target doses of 5 kGy, 10 kGy, and 20 kGy, with 0 kGy (untreated) samples as controls. Samples were analyzed for total fungal load using culture methods, the quantity of total aflatoxins and fumonisins using ELISA, and the presence of Aspergillus and Fusarium spp. nucleic acids using qPCR for just control samples. There was a significant positive correlation in the control samples between total Aspergillus and aflatoxin levels (r = 0.54; p = 0.007) and total Fusarium and fumonisin levels (r = 0.68; p < 0.001). Exposure to eBeam doses 5 kGy and greater reduced fungal loads to below limits of detection by plating (<1.9 log(CFU/g)). There was also a significant (p = 0.03) average reduction of 0.3 log (ng/g) in aflatoxin at 20 kGy (range from −0.9 to 1.4 log (ng/g)). There was no significant reduction in fumonisin even at 20 kGy. eBeam doses below 20 kGy did not reduce mycotoxins. These results confirm the sensitivity of fungi to eBeam doses in a naturally contaminated maize slurry and that 20 kGy is effective at degrading some pre-formed aflatoxin in such maize preparations.

Snake envenomations constitute a worldwide neglected tropical disease, with the vast majority of lethal bites inflicted by front-fanged snakes from the viperid and elapid groups. Rear-fanged snakes (colubrids) were often considered harmless and as a result, are much less studied, but several documented deaths have suggested potent venom in this group as well. The largest European snake (Malpolon monspessulanus monspessulanus), known as the “Montpellier snake”, is such a rear-fanged snake that belongs to the Lamprophiidae family. Its venom remains largely unknown but cases of envenomation with neurological symptoms have been reported. Here, we provide the first insights into the composition of its venom using mass spectrometry methods. First, liquid chromatography coupled mass spectrometry analysis of the manually collected venom samples reveals a complex profile, with the majority of masses encompassing the range 500–3000 Da, 4000–8000 Da, and 10 000–30 000 Da. Next, shotgun proteomics allowed the identification of a total of 42 different known families of proteins, including snake venom metalloproteinases, peptidase M1, and cysteine-rich secretory proteins, as the most prominent. Interestingly, three-finger toxins were not detected, suggesting that neurotoxicity may occur via other, yet to be determined, toxin types. Overall, our results provide the basis for a better understanding of the effects of a peculiar snake venom on human symptomatology, but also on the main prey consumed by this species.

Black widow spiders (Latrodectus sp.) are distributed worldwide, and in Albania the L. tredecimguttatus Rossi, 1790 has been the dominant spider. Other medically important spiders in Albania include the brown recluse with symptoms known as loxoscelism, the false black widow and the egg sac spiders; the last two inducing similar symptoms to a wasp sting. Methods: The data analyzed is from a decade-long study of 125 patients hospitalized in the regional hospital of Fier County, in the Western Lowland of Albania from May 2009 and to October 2018. Objective: Although the venom is rarely fatal, the recent spider bites raise questions about the influence of higher air temperatures on their possibly increased toxicity. Results: Significantly the severity of the α-latrotoxin rises during the summer, when human–spider contact frequency is higher and when the black widow spiders have an increased motivation to protect their egg sacs. Conclusion: This study revealed an increased severity of the black widow bites with respect to patient health, shown via all the severe systemic symptoms, during those months with higher temperatures.

The isolation and characterization of individual snake venom components is important for a deeper understanding of the pathophysiology of envenomation and for improving the therapeutic procedures of patients. It also opens possibilities for the discovery of novel toxins that might be useful as tools for understanding cellular and molecular processes. The variable venom composition, toxicological and immunological properties of the common vipers (Vipera berus berus) have been reviewed. The combination of venom gland transcriptomics, bottom-up and top-down proteomics enabled comparison of common viper venom proteomes from multiple individuals. V. b. berus venom contains proteins and peptides belonging to 10–15 toxin families: snake venom metalloproteinase, phospholipases A₂ (PLA₂), snake venom serine proteinase, aspartic protease, L-amino acid oxidase (LAAO), hyaluronidase, 5′-nucleotidase, glutaminyl-peptide cyclotransferase, disintegrin, C-type lectin (snaclec), nerve growth factor, Kunitz type serine protease inhibitor, snake venom vascular endothelial growth factor, cysteine-rich secretory protein, bradykinin potentiating peptide, natriuretic peptides. PLA₂ and LAAO from V. b. berus venom produce more pronounced cytotoxic effects in cancer cells than normal cells, via induction of apoptosis, cell cycle arrest and suppression of proliferation. Proteomic data of V. b. berus venoms from different parts of Russia and Slovakian Republic have been compared with analogous data for Vipera nikolskii venom. Proteomic studies demonstrated quantitative differences in the composition of V. b. berus venom from different geographical regions. Differences in the venom composition of V. berus were mainly driven by the age, sex, habitat and diet of the snakes. The venom variability of V. berus results in a loss of antivenom efficacy against snakebites. The effectiveness of antibodies is discussed. This review presents an overview with a special focus on different toxins that have been isolated and characterized from the venoms of V. b. berus. Their main biochemical properties and toxic actions are described.