Stingray Attacks and their Treatment 1
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Abstract:
SummaryThe habits of stingrays, stinging action, types of caudal appendages and the structure of the venom apparatus of stingrays are described and the results of experimental studies on stingray venom, the clinical characteristics of stingray wounds and their treatment are briefly discussed.Keywords:
Stingray
Appendage
Centipede
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Stingray
Presentation (obstetrics)
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As the landscape becomes more urbanized, snakebites have increasingly become uncommon presentations to the emergency departments in Singapore, while snakebites causing significant envenomation are even rarer. In this case report, we discuss a 55-year-old man who had significant envenomation from a Rhabdophis keelback (Rhabdophis subminiatus) and who was successfully treated with haemato-toxic polyvalent antivenom (HPAV). He initially presented with pain, swelling and bleeding over his wound. Due to a deterioration in his coagulation profile, he was given two doses of HPAV which is typically reserved for viperid snakes instead. Following administration of the anti-venom, the patient's coagulation profile improved and the local soft tissue effects of the venom resolved. He did not manifest any adverse effects and was discharged uneventfully about 72 hours after the snakebite. The cross-neutralization potential of HPAV for Rhabdophis Colubrid venom in this case study suggests that there may be a possible common underlying chemical structure and pathophysiology among the venom proteins of various snake species. Given that Rhabdophis-specific antivenom is unavailable in most countries, this cross-neutralization strategy deserves further consideration and evaluation in similar circumstances. The patient was successfully treated using HPAV with resolution of envenomation and discharged uneventfully. The possible cross neutralization potential of HPAV for Rhabdophis (colubrid) venom in our case may suggest a possible common underlying structure and pathophysiology of venom proteins amongst different snake species.
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Neotropical stingrays have stingers at the base of the tail, which are used in self-defense and are covered with an epithelium containing mucous and venom glands. The stingray then sinks its stinger into the victim, causing an extremely painful wound, which can result in tissue necrosis. Medical treatment is based on the use of painkillers, anti-inflammatory drugs and antibiotics, as to date there is no specific antidote for this type of envenomation. Public health authorities should therefore plan measures aimed at the treatment and epidemiologic reporting of stingray envenomation so as to encourage, and provide a basis for, the relevant organs to implement measures to raise environmental awareness, train health professionals to treat victims of envenomation and undertake studies to produce specific serum therapies.
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Pseudoaneurysm
Debridement (dental)
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Diagnosis of Loxosceles reclusa envenomations is currently based upon clinical presentation. An enzyme-linked immunosorbent assay (ELISA) can detect surface Loxosceles venom at the envenomation site, allowing diagnostic confirmation. The length of time that venom on the skin is recoverable non-invasively is unknown.To investigate duration of recoverable venom antigen, whole venom and fractionated sphingomyelinase D venom aliquots were injected subcutaneously in New Zealand White rabbits. Cotton and Dacron swabs were compared for venom recovery over a 21-day period using a surface swab technique.Significant amounts of Loxosceles reclusa antigen were found on the surface of rabbit skin after experimental injection of whole venom and sphingomyelinase D. The duration of recoverable antigen using this experimental model appears to be at least two weeks and as long as 21 days in some cases.Because the duration of the recoverable antigen is seen to be at least two weeks, the ELISA venom test appears capable of detecting venom on most patients presenting with Loxosceles envenomations. This detection system will allow the physician more accurate determination of whether the lesion is from a brown recluse spider or some other agent that can cause this type of necrotic ulcer.
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Snakebite envenomation is a serious neglected tropical disease, and its management is often complicated by the diversity of snake venoms. In Asia, pit vipers of the Ovophis species complex are medically important venomous snakes whose venom properties have not been investigated in depth. This study characterized the venom proteomes of Ovophis convictus (West Malaysia), Ovophis tonkinensis (northern Vietnam, southern China), and Ovophis okinavensis (Okinawa, Japan) by applying liquid chromatography-tandem mass spectrometry, which detected a high abundance of snake venom serine proteases (SVSP, constituting 40-60% of total venom proteins), followed by phospholipases A2, snake venom metalloproteinases of mainly P-III class, L-amino acid oxidases, and toxins from other protein families which were less abundant. The venoms exhibited different procoagulant activities in human plasma, with potency decreasing from O. tonkinensis > O. okinavensis > O. convictus. The procoagulant nature of venom confirms that consumptive coagulopathy underlies the pathophysiology of Ovophis pit viper envenomation. The hetero-specific antivenoms Gloydius brevicaudus monovalent antivenom (GbMAV) and Trimeresurus albolabris monovalent antivenom (TaMAV) were immunoreactive toward the venoms, and cross-neutralized their procoagulant activities, albeit at variably limited efficacy. In the absence of species-specific antivenom, these hetero-specific antivenoms may be useful in treating coagulotoxic envenomation caused by the different snakes in their respective regions.
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Viperidae
VIPeR
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