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Splenic hematoma secondary to snake bite is a potential complication due to snake envenomation and poses a significant risk to the health of the patients. Although relatively rare, this complication once diagnosed, should be initiated with timely anti-venom administration and supportive care. Clinicians must be aware of any signs of hematological abnormalities in snakebite patients, as the development of splenic hematoma can have serious implications for patient outcomes. Awareness of this potential complication and multidisciplinary collaboration among medical teams are crucial to ensuring effective management and optimal patient care in these clinical scenarios. Understanding this concern can improve patient prognosis and advance the overall approach to snakebite management in healthcare settings.

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There are an estimated 5.4 million snakebite cases every year. People with snakebite envenoming suffer from severe complications, or even death. Although some review articles cover several topics of snakebite envenoming, a review of the cases regarding cerebral complications, especially rare syndromes, is lacking. Here, we overview 35 cases of snakebite by front-fanged snakes, including Bothrops, Daboia, Cerastes, Deinagkistrodon, Trimeresurus, and Crotalus in the Viperidae family; Bungarus and Naja in the Elapidae family, and Homoroselaps (rare cases) in the Lamprophiidae family. We also review three rare cases of snakebite by rear-fanged snakes, including Oxybelis and Leptodeira in the Colubridae family. In the cases of viper bites, most patients (17/24) were diagnosed with ischemic stroke and intracranial hemorrhage, leading to six deaths. We then discuss the potential underlying molecular mechanisms that cause these complications. In cases of elapid bites, neural, cardiac, and ophthalmic disorders are the main complications. Due to the small amount of venom injection and the inability to deep bite, all the rear-fanged snakebites did not develop any severe complications. To date, antivenom (AV) is the most effective therapy for snakebite envenoming. In the six cases of viper and elapid bites that did not receive AV, three cases (two by viper and one by elapid) resulted in death. This indicates that AV treatment is the key to survival after a venomous snakebite. Lastly, we also discuss several studies of therapeutic agents against snakebite-envenoming-induced complications, which could be potential adjuvants along with AV treatment. This article organizes the diagnosis of hemotoxic and neurotoxic envenoming, which may help ER doctors determine the treatment for unidentified snakebite.

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BACKGROUND: Snakebite envenomation (SBE) is a serious and potentially life-threatening condition that most often targets rural, subsistence-based farmers in sub-Saharan Africa. Rwanda is home to 13 venomous and medically important snake species. Those bitten are known to seek care from traditional healers and/or formal health facilities. No information is available on patient management at government health facilities. METHODS: This quantitative evaluation aimed to characterize knowledge, attitudes and practices related to snakebite management in Rwanda. Target respondents included physicians working at hospitals with the highest SBE caseload and medical interns. Respondents were asked to complete questionnaires on paper or online through Qualtrics. RESULTS: Overall, 105 physicians and 171 interns agreed to participate. Our findings suggest that overall knowledge scores were low for both groups (mean 49.4%, minimum-maximum 31.3-70.8%). Respondents were keen to receive SBE training but often lacked essential supplies needed to adhere to recommended guidelines for SBE management. One-third of respondents (34.8%) believed that traditional healers could manage SBE successfully and two-thirds (66.3%) felt that black stone therapy was an appropriate first aid practice. CONCLUSIONS: These findings indicate a clear need for improved curricula related to SBE, enhanced supply chain management and practical mechanisms for supporting clinicians.

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BACKGROUND: Snakebites are common among rural communities. The aim of this study was to ascertain the differences between paediatric and adult snakebite patients regarding severity, management and outcome. METHODS: This study included a total of 878 patients admitted to Ngwelezana Hospital, with a snakebite or snakebite-related complication, from September 1, 2008 to December 31, 2014. This included 274 paediatric patients (13 years and younger) and 604 adults. RESULTS: There was a male predominance (56%) in the paediatric group and a female predominance (51%) amongst adults. The duration between the time of the bite and presentation to the hospital was significantly longer in children. The vast majority of children and adults presented with cytotoxic envenomation. Laboratory parameters were worse amongst children in the cytotoxic group. 53 children (19%) and 44 adults (7%) required antivenom administration. Of those who received antivenom, 25% suffered adverse reactions in the paediatric group and 20% in the adult group. 56 Children (20%) underwent one or more procedures on their affected limbs compared to 26 adults (4%). CONCLUSION: The paediatric population carries a higher risk for serious morbidity and should be treated at a facility with the necessary resources. Children require antivenom more often due to severe envenomation. Delayed presentation carries significant morbidity.

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ETHNOPHARMACOLOGICAL RELEVANCE: In the countryside, there are some limitations with the use of venom antisera to manage snake bites. Due to poor access to healthcare and as a result of the difficulty in receiving treatment for cases of snake bites, most rural people in Ghana, a West African country, rely on plant medicine as a first aid to manage cases of venomous snakebite. This calls for more research into the species of plants used to medically manage snakebite envenomation. AIM OF THE STUDY: This review sought to present plants that are used in managing snakebite cases and also gather data supporting their use. METHODOLOGY: This is a systematic search and review of information obtained from textbooks and databases such as PubMed and ScienceDirect between January 1975 and August 2020. RESULTS: A search done identified 43 plant species and these were found to belong to 25 taxonomic families with the most frequent ones being, Fabaceae, Euphorbiaceae, Apocynaceae, and Solanaceae. Experimental data gathered indicate that among the many plants identified to be used to manage snakebites, only 5 were found with anti-venom in vitro and in vivo evidence-based data. CONCLUSION: Data collated hint that a few plant species identified namely Anacardium occidentale, Euphorbia hirta, Mimosa pudica, Musa paradisiaca and Mangifera indica, work by targeting diverse physiopathological and biochemical processes involved in the clinical manifestations of snakebites. This review has also unearthed knowledge gaps that can form the basis for broad investigations and development of these and other medicinal plants into useful anti-venom medications.

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OBJECTIVE：To investigate the effects and mechanism of Jidesh eng anti-venom tablet on local wound inflammation and systemic inflammatory response of snake bite patients. METHODS ：Totally 64 patients with snake bite admitted to our hospital during Jun. 2018-Jun. 2020 were randomly divided into control group and observation group ，with 32 cases in each group. Both groups received routine treatment ，such as debridement ，drainage，flushing，sealing，anti-venom，anti-infection，anti-fibrinolysis and anti-shock. Observation group was additionally given Jidesheng anti-venom tablet for internal and external use ，for consecutive 7 d. Related indexes of systemic inflammatory response ，local wound condition ，hospital stay ，laboratory indexes of important organs，coagulation function index ，wound inflammatory cell counts ，serum levels of inflammatory cytokines and chemokine ，the occurrence of ADR were compared between 2 groups. RESULTS ：After treatment ，most of related indexes of systemic inflammatory response （RR，HR and WBC ），local wound condition （local pain disappearance time ，wound detumescence time ）， hospital stay ，laboratory indexes of important organs （AST，ALT，Scr，BUN，CKB，CK-MB），coagulation function index （t-PA， PAI-1，TAT，SFMC），wound inflammatory cell （macrophages，neutrophils，lymphocytes）count，serum levels of inflammatory cytokines（TNF-α，IL-1，IL-6，hs-CRP，NF-κB）and chemokine （MCP-1，CXCL-8）in 2 groups were significantly better than before treatment （P＜0.05）；most indexes of observation group were significantly better than those of control group （P＜0.05）. No severe ADR was found in 2 groups. CONCLUSIONS ：Jidesheng anti-venom tablet as auxiliary treatment can significantly reduce the local wound inflammation and systemic inflammatory response of snake bite patients ；the mechanism is probably related to reducing the levels of chemokine MCP- 1 and CXCL- 8 and inflammatory cytokines hs-CRP and NF-κB.

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Objective: To evaluate antioxidant, cytotoxic, and anti-venom capacity of crude bark extracts of Alstonia parvifolia Merr. Methods: Gas chromatography-mass spectrometry (GC-MS) and energy dispersive X-ray analyses were accomplished to characterize the chemical constituents of Alstonia parvifolia. Biochemical characterization was evaluated using an inhibitory phospholipase A 2 (PLA 2) assay, DPPH, and cytotoxicity assays. Using the constituents listed in the GC-MS analyses, molecular docking was conducted to inspect the binding energies between the chosen compounds and selected PLA 2 isoforms. Results: GC-MS analyses showed that the Alstonia parvifolia crude extract consisted predominantly of acetylmarinobufogenin (14.89%), γ-sitosterol (10.44%), 3-O-methyl-D-glucose (5.88%), 3,5-dimethoxy-4-hydroxyphenylacetic acid (5.30%), (2α,5α)-17-methoxyaspidofractinin-3-one (AFM) (4.08%), and 2,3,5,6,7,8,9-heptahydro-1-phenyl-5-(p-chlorophenylimino)-1H-benzo[e] [1],[4] thiazepine (HPT) (1.37%). The principal elemental components of Alstonia parvifolia were Ca (4.012%) and K (1.496%), as exhibited by energy dispersive X-ray examination. Alstonia parvifolia showed significant free radical scavenging ability (IC 50: 0.287 mg/mL) and was non-cytotoxic to normal HDFn cells (IC 50 >100 μg/mL). Moreover, Alstonia parvifolia was favorably cytotoxic to MCF-7 (IC 50: 4.42 μg/mL), followed by H69PR, HT-29, and THP-1, with IC 50 values of 4.94, 5.07, and 6.27 μg/mL, respectively. Alstonia parvifolia also displayed notable inhibition against PLA 2 activity of Naja philippinensis Taylor venom with IC 50 of (15.2 ± 1.8) μg/mL. Docking and cluster analyses projected negative binding energies from AFM (-6.36 to -9.68 kcal/mol), HPT (-7.38 to -9.77 kcal/ mol), and acetylmarinobufogenin (-7.22 to -9.59 kcal/mol). These calculations were for the particular interactions of Alstonia parvifolia constituents to PLA 2 homologues where the utmost affinity was detected in HPT owing to the dipole interactions with amino acid residues. Conclusions: The bark extract of Alstonia parvifolia shows great potential as an anti-venom agent due to its low cytotoxic profile, remarkable PLA 2 inhibition, and docking binding energies between its bioactive constituents and PLA 2 homologues.

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Objective: To evaluate the neutralizing effects of flavonoids on snake venom toxicity by stand-alone and combinatorial approaches. Methods: Synthetic flavonoids were assessed, either individually or in combination with antivenom, for their neutralization of phospholipase A

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Cytotoxic snakebite envenomation is prevalent in Kwazulu-Natal and may be associated with significant physical disability. The aim of this study was to provide an overview of the effects of cytotoxic envenomation in children. The patient population were all patients attending the Emergency Department at Ngwelezana Tertiary Hospital with snakebite from December 2014 to March 2015. All children 13 years or younger presenting with painful progressive swelling (PPS) following snakebite were included in this study. They were further classified according to severity: mild, moderate and severe. Patient demographic and clinical data was collected prospectively. Fifty-one children were included in this study. Nine were classified as mild, 24 as moderate and 18 as severe. The median time of presentation after bite was 6 h in the mild group, 7 h in the moderate group and 12 h in the severe group. There was a positive correlation between increasing severity and INR (p=< .00001) and no correlation between WCC (p = .175) or renal function and severity (p = .963). A total of 11 children (22%) developed an acute kidney injury (AKI). A total of 23/51 patients received antivenom; 25% of patients with moderate cytotoxicity and 94% of patients with severe cytotoxicity. Thirteen percent developed allergic reactions (3/23) and 57% (13/23) anaphylaxis. A total of 15 patients underwent one or more procedures on their affected limbs. There was one recorded mortality during this period, related to severe anaphylaxis following antivenom administration. Access to healthcare for antivenom administration is often delayed and ongoing education within affected areas is advised. Whilst majority of snakebite victims can be adequately managed with basic supportive measures, early identification of severe envenomation is crucial to enable timeous antivenom administration and prevention of further complications such as compartment syndrome and loss of limb. Hypersensitivity reactions are alarmingly common following antivenom administration in children and strict protocols should be followed when administering antivenom.

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ETHNOPHARMACOLOGICAL RELEVANCE: Snake bite is a major occupational hazard in tropical and subtropical countries including India as per the World Health Organization. Naja naja (Indian cobra) and Daboia russelli (Russell's viper) are the two poisonous snakes commonly associated with human mortality in India. Andrographis serpyllifolia (Rottler ex Vahl) Wight has been documented in ethnobotanical records as a plant possessing potent anti-snake venom activity. AIM OF THE STUDY: The present study is aimed for systematic evaluation of in vitro anti-venom potential of various solvent based leaf extracts of A. serpyllifolia against toxic venom enzymes of Naja naja and Daboia russelli. MATERIALS AND METHODS: Different solvent based leaf extracts of A. serpyllifolia were tested against the snake venoms of Naja naja and Daboia russelli obtained from Irula Snake Catchers Industrial Co-operative Society Limited, Kancheepuram, Tamil nadu, India. Three different in vitro neutralization assays such as indirect hemolysis, procoagulent and lytic activities and seven in vitro enzyme inhibition assays such as protease, acetylcholinesterase, phosphomonoesterase, phosphodiesterase, 5'nucleotidase, phospholipase A2, hyaluronidase and post synaptic acetylcholine receptor binding activity were carried out according to standard protocols. The results were analyzed using the standard ANOVA procedures. RESULTS: Among various solvent based leaf extracts of A. serpyllifolia tested, aqueous extract showed maximum neutralizing and inhibitory activities against Naja naja and Daboia russelli venoms. CONCLUSIONS: The various in vitro enzymatic studies reveal that the aqueous leaf extract of A. serpyllifolia plant could inhibit most of the toxic enzymes of the Naja naja and Daboia russelli venoms which could be further confirmed by in vivo studies.

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In this study, preparation of a solid-phase microextraction fiber of polydimethylsiloxane (PDMS) polymer in its blends with polystyrene (PS) via electrospinning process, on a stainless steel wire has been reported. The electrospining enhancement of PDMS solutions in the presence of PS is found due to the increase in the viscosity of the mixed solutions. Characteristics of the fibers were inspected by energy dispersive X-ray spectroscopy, scanning electron microscopy and field emission scanning electron microscopy. The applicability of the coating was assessed for headspace solid phase microextraction (SPME) of some residual solvents (Diethyl Ether, Toluene and Chloroform) from biological products (Anti venin and Foot-and-mouth disease vaccine) followed by gas chromatography-mass spectrometry. The effects of extraction time and temperature, desorption time and temperature, agitation rate and ionic strength on the extraction efficiency were investigated. Under optimized conditions, limits of detection in the range of 2-10 µg L-1 and limits of quantification in the range of 10-50 µg L-1 were obtained. The method showed linearity in a wide range with a correlation coefficient greater than 0.99. In addition, the obtained inter-day and intra-day precisions were in the range of 1.57-8.28% and 4.87-11.72%, respectively. The thermal stability of the fiber was also investigated and it was found to be durable at 230 °C for 450 min. Furthermore, the proposed method was successfully applied for quantification of chloroform in Foot-and-mouth disease vaccine and diethyl ether and toluene in Anti-venin with recoveries in the range of 78.84-123.01%.

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Phospholipase A2 (PLA2) is the main constituent of snake venom. PLA2 enzymes catalyze the Ca2+ dependent hydrolysis of 2-acyl ester bonds of 3-sn-phospholipids, releasing fatty acids and lysophospholipids. Inside the body of the victim, PLA2 from snake venom induces either direct or indirect pathophysiological effects, including anticoagulant, inflammatory, neurotoxic, cardiotoxic, edematogenic, and myotoxic activities. Therefore, there is a need to find the potential inhibitors against PLA2 responsible for snakebite. In this study, we employed in silico and in vitro methods to identify the potential inhibitor against PLA2. Virtual screening and molecular docking studies were performed to find potent inhibitor against PLA2 using Traditional Chinese Medicine Database (TCM). Based on these studies, Scutellarin (TCM3290) was selected and calculated by density functional theory calculation at B3LYP/6-31G**++ level to explore the stereo-electronic features of the molecule. Further, molecular docking and DFT of Minocycline was carried out. Quantum polarized ligand docking was performed to optimize the geometry of the protein-ligand complexes. The protein-ligand complexes were subjected to molecular dynamics simulation and binding free energy calculations. The residence time of a protein-ligand complex is a critical parameter affecting natural influences in vitro. It is nonetheless a challenging errand to expect, regardless of the accessibility of incredible PC assets and a large variety of computing procedures. In this metadynamics situation, we used the conformational flooding technique to deal with rank inhibitors constructions. The systematic free energy perturbation (FEP) protocol and calculate the energy of both complexes. Finally, the selected compound of TCM3290 was studied in vitro analysis such as inhibition of PLA2 activity, hyaluronidase activity and fibrinogenolytic activity. The TCM3290 had a more binding affinity compare to Minocycline, and interacted with the key residues of TYR63 and GLY31. DFT represented the highest HOMO and LUMO energy of 0.15146 eV. MD simulation with 100 ns proved that an inhibitor binding mode is more stable inside the binding site of PLA2. In vitro analysis shows that TCM3290 significantly neutralized by PLA2. The above observations confirmed that Scutellarin (TCM3290) had a potent snake venom neutralizing capacity and could hypothetically be used for therapeutic drives of snakebite envenomation.

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Snakebite envenomation is a life-threatening disease that was recently re-included as a neglected tropical disease (NTD), affecting millions of people in tropical and subtropical areas of the world. Improvement in the therapeutic approaches to envenomation is required to palliate the morbidity and mortality effects of this NTD. The specific therapeutic treatment for this NTD uses snake antivenom immunoglobulins. Unfortunately, access to these vital drugs is limited, principally due to their cost. Different ethnic groups in the affected regions have achieved notable success in treatment for centuries using natural sources, especially plants, to mitigate the effects of snake envenomation. The ethnopharmacological approach is essential to identify the potential metabolites or derivatives needed to treat this important NTD. Here, the authors describe specific therapeutic snakebite envenomation treatments and conduct a review on different strategies to identify the potential agents that can mitigate the effects of the venoms. The study also covers an increased number of literature reports on the ability of natural sources, particularly plants, to treat snakebites, along with their mechanisms, drawbacks and future perspectives.

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INTRODUCTION: Russell's viper envenoming in dogs is a significant problem in Sri Lanka. The current study focused on investigating clinical profile, laboratory findings of three selected tests and to develop a treatment strategy with Indian polyvalent Anti-Venom Serum (AVS). It was also intended to report adverse effects and complications caused by both Russell's viper venom (RVV) and AVS in Russell's Viper (RV) envenomed dogs. OBJECTIVE: To evaluate and report the clinical manifestations, to find out the minimum effective vials of AVS and to record AVS induced adverse reactions of RV envenoming in dogs. MATERIALS AND METHODS: A prospective study was conducted on Russell's viper bitten dogs (n = 65) admitted to the Veterinary Teaching Hospital (VTH) in Sri Lanka. Indian polyvalent AVS was used to treat all the envenomed dogs. The number of vials of AVS that was administered to a patient was decided upon by a second degree polynomial model with a number of vials of AVS in the X axis verses Prothrombine Time (PT), Activated Partial Thromboplastine Time (aPTT) and Clotting Time (CT) in the Y axis respectively. RESULTS: Varying degrees of pain were exhibited by all the victim dogs. Mild swelling and necrosis at the site of bite was seen in 54% (n = 35) and 37% (n = 24) of dogs respectively. Prolonged values of, PT, aPTT and CT were seen from all the RV envenomed dogs. The mean leukocyte count in these dogs was 39.79 × 103/µL (normal range; 4-20 × 103/µL) (IQR:29.05 × 103/µL-45.92 × 103/µL). Statistical analysis showed that the initial vials of 7 AVS would be the minimum required vials. Therefore, a range of 6-15 AVS vials in total were administered to these dogs and in 7.6% (n = 5) of dogs, the results of PT, aPTT and CT became normal with 6 AVS vials at 32-97 minutes. Acute Renal Failure (ARF) was detected from 29% (n = 19) of dogs as a complication. CONCLUSIONS: Systemic clinical signs of haemorrhagic lesions, cardio respiratory toxicities were common in Russell's viper envenomed dogs. Initially 6 vials of AVS must be administered. AVS induced reactions were reported commonly. Russell's viper envenoming was found to be lethal in dogs.

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Euphorbia hirta L. from the family of Euphorbiaceae is an annual herb, which grows as a roadside weed in most tropical countries. It is prominently used by the traditional healers in rural India for the treatment of snakebites. However, the mechanisms and the major bioactive compounds behind its inhibition activity are relatively unknown. From our preliminary in silico studies, it was found that a group of pentacyclic triterpenoids from this plant are playing a major role in inhibiting the snake venom proteins. The present study was aimed at standardizing methods for obtaining callus from this medicinal plant at a much faster rate by hormone pretreatment of explants and, thus, by developing suspension cultures to obtain bioactive secondary metabolites in vitro. The results were promising that longer incubation of explants with hormone treatment showed early induction of callus. The major bioactive compounds responsible for the anti-snake venom activity were characterized from natural plant material as well as from suspension cultures, and the efficiency was found to be relatively high. The secondary metabolite analysis from suspension culture and natural plant extracts revealed that a major compound 'Taraxerol' and its derivatives was found abundant along with few other triterpenoids. This compound showed high inhibitory activity against pit viper snake venoms from our in silico studies with molecular docking tools. Hence, this study with identification of potential bioactive compounds against snake venom with standardization of In vitro culture methods would help in developing natural alternative medicine for snakebites in near future.

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Abstract In this study, mango seed kernels extract contained a considerable amount of phenolics and flavonoids (17,400 and 3325 mg/100 g seed, respectively). The HPLC profiling revealed that hesperidin was the major phenolic compound of the mango seed kernels extract. This is the first report find hesperidin in mango extracts. The phenolic compounds of mango seed kernels extract were effective in scavenging free radicals of DPPH and ABTS with IC50 values of 47.3 and 7.9 µg/ml, respectively. The total antioxidant activity of mango seed kernels extract based on the reduction of molybdenum was also measured. The phenolic compounds of mango seed kernels extract potentially inhibited the protease, fibrinogenase, phospholipase A2, l-amino acid oxidase, hyaluronidase, and hemolytic activities of the most dangerous Cerastes cerastes and Echis coloratus viper venoms. The phenolic compounds of mango seed kernels extract could completely neutralize the hemorrhage and lethality of both venoms in experimental animals. It could be concluded that the mango seed kernels extract phenolic compounds with potential antioxidant activity are considered as a new avenue in the viper bite treatment.

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The present study was aimed to explore the anti-venom activity of Aristolochia indica and Piper nigrum plants against the centipede (Scolopendra moristans) envenomation in animal model. In vtiro phytochemical, antioxidant and blocking of proteolysis were carried out by using standard spectrophotometric methods. In vivo anti-venom activity of methanol extracts was determined using Wistar albino rats after fixing lethal and effective doses. The electrolytes, lipid, liver, kidney, hematological parameters were analyzed and histopathology of skin and liver were also examined. Anti-skin cancer by MTT method and HPLC analysis were also carried out. The CAIPN extract showed higher total phenolics (150.65 ± 0.08 mg GAE/g extract) and flavonoids (158.97 ± 0.93 mg RE/g extract) content. Further, the same extract revealed the higher molybdenum reducing, inhibition of lipid peroxidation (80.08 ± 0.22%), DPPH radical scavenging (3.05 µg/mL), and blocking of proteolysis activities (96.45 ± 0.04%). The parameters like hypersensitivity, electrolytes, lipids, blood components, liver and kidney marker of the CAIPN methanol extract (200 mg/kg) treated envenomated rats was remarkable and same as in the normal animals. Such status was also achieved by RBAI and SPN at 600 mg/kg. The histopathological scoring of skin and liver confirmed the venom neutralizing activity of CAIPN. Also, the CAIPN methanol extract was notable in anti-skin cancer activity (208 µg/mL). The presence of the ferulic acid (04 ± 0.09 µg/mg) and quercetin (35.30 ± 0.30 µg/mg) like compounds was confirmed by HPLC analysis. Hence, the present investigation results conclude that the CAIPN was significant in their action and this polyherbal formulation could be considered as a new source for the pharmaceutical industries to develop a new effective, ecofriendly anti-venom drug.

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Scorpion sting envenoming poses major public health problems. The treatment modalities include antivenoms, chemical antidotes and phytotherapy, with varying degrees of effectiveness and side effects. In this investigation, we reviewed the use of Saudi medicinal plants for the treatment of scorpion sting patients. The relevant literature was collected using the online search engines including Science Direct, Google and PubMed with the help of specific keywords. We also used the printed and online resources at our institutional library to gather the relevant information on the use of medicinal plants for the treatment of scorpion sting patients. A descriptive statistics was used for data compilation and presentation. The results of this survey showed the use of at least 92 medicinal plants with beneficial effects for treating victims of stings of different scorpion species. These commonly used herbs spanned to 37 families whilst different parts of these plants were employed therapeutically for alleviation of envenomation symptoms. The application of leaves (41%) was preferred followed by roots (19%), whole plant (14%) and seeds (9%). The use of latex (4%), stem (3%), flowers (3%) and bark (3%) was also reported. In some cases, tannin (2%), rhizome (1%) and shoot (1%) were also used. In conclusion, herbal medicines are effectively used for the treatment of patients with scorpion envenomation. This type of medication is free from side effects as observed with chemical antidotes or antivenom therapy. It is important to identify the active ingredients of herbal drugs for improving their therapeutic potential in traditional medicine.

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OBJECTIVES: Snakebite is an underestimated medical and surgical emergency in developing countries responsible for a high disease burden. Optimal management of snake envenomation in these resource-limited settings is precluded by several public health challenges. In this review, we discuss the disease burden of snakebites in Cameroon and the public health challenges of its management in view of making recommendations essential for policy-making. MEDLINE, African Journals Online and Google Scholar were searched from January 1990 to February 2017 for studies addressing snakebite in Cameroon. Our search extended to include grey literature from book chapters, conference proceedings, theses and documents from organizations. RESULTS: Our results suggest that snakebites pose a significant health and economic burden in Cameroon. A composite of factors contributes to the challenge of managing snakebites in Cameroon and include: inadequate disease surveillance; poor health-seeking behaviours of patients; under-production and scarcity of anti-venom serum and the relatively high cost of anti-venom serum. There is an urgent need to revamp the current health policies through health education, promotion and building of sustainable health systems. Disease surveillance and management can be improved by providing refresher courses for healthcare providers and subsidization of the prices of anti-venom serum in pharmacies in the country.

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SaPLIγ is a novel gamma phospholipase A2 inhibitor (PLI) recently isolated from Sinonatrix annularis, a Chinese endemic non-venomous snake. To explore the neutralization effects of saPLIγ in snakebite envenomation, a dose equivalent to LD50 of Deinagkistrodon acutus, Agkistrodon halys and Naja atra venom with/without saPLIγ was inoculated into the gastrocnemius muscle of female Kunming mice. The ability of saPLIγ to inhibit myonecrosis and systemic toxicity were evaluated through investigations of muscle histopathology, and determination of the serum levels of creatine kinase (CK), lactate dehydrogenase isoenzyme1 (LDH1) and aspartate transferase (AST). Edema of the gastrocnemius muscle was evaluated by calculating the width difference between the inoculated limb and the contralateral leg. Desmin loss in the gastrocnemius muscle was determined by Western blot analysis. Co-immunoprecipitation and shotgun LC-MS/MS analyses were performed to identify venom proteins that interact with saPLIγ. All the envenomed mice had significantly elevated serum CK, LDH1 and AST levels, whereas the levels were decreased significantly in the presence of saPLIγ. Histopathological evaluation of gastrocnemius muscle sections showed severe snake venom-induced damage, characterized by leukocyte infiltration and erythrocyte leakage, leading to local edema. Myonecrosis, hemorrhage and desmin loss were significantly attenuated by saPLIγ. SaPLIγ interacted with a wide range of venom proteins, including PLA2s, metalloproteinases and C type lectins, which may contribute to broad anti-venom effects.

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