Livestock herding and Fulani ethnicity are a combined risk factor for development of early adverse reactions to antivenom treatment: Findings from a cross-sectional study in Nigeria

BACKGROUND: Adverse reactions to antivenom considerably complicate the clinical management of snakebite envenomed patients because it necessitates a temporary suspension of life-saving antivenom, increases costs and can compromise patient outcomes. This study sought to explore the association between cattle-herding occupation and ethnic group and the occurrence of early adverse reactions to antivenom. METHODS: This cross-sectional study was conducted between the 25th April and 11th July 2011 at the Kaltungo General Hospital in north east Nigeria. The exposure variable of cattle-herding occupation showed a strong correlation with the ethnic group variable, thus these were combined into a new variable with three categories (Fulani and herder, either Fulani or herder, and neither Fulani nor herder). The outcome variable was the occurrence of early adverse reactions, defined as any new symptoms occurring within 6 hours of antivenom administration. Odds Ratios were estimated using multivariable logistic regression models controlling for potential confounders. RESULTS: Among 231 envenomed snakebite victims, the overall incidence of early adverse reactions was 11.9% (95% confidence intervals: 8.0–16.9%). Patients who were Fulani and herders had a higher incidence of early adverse reactions compared to patients who were neither Fulani nor herders (20% vs 5.7%). After adjusting for age and gender, victims who were Fulani and herders were 5.9 times more likely to have an early adverse reaction, compared to victims who were neither Fulani nor herders (95% CI: 1.88–18.59; p = 0.002). INTERPRETATION: To the best of our knowledge, this is the first study to provide evidence of higher odds of early adverse reactions among patients from a particular occupation and/or ethnic group. We recommend that snake envenomed patients of Fulani origin be especially closely monitored for adverse reactions, that hospitals receiving these patients be appropriately resourced to manage both envenoming and adverse reactions and that premedication with adrenaline should be considered. Our findings provide an argument for speculation on the influence of immunological or lifestyle-related differences on the occurrence of early adverse reactions to antivenom

Randomised Controlled Double-Blind Non-Inferiority Trial of Two Antivenoms for Saw-Scaled or Carpet Viper (Echis ocellatus) Envenoming in Nigeria

Snake bite threatens millions of poor rural folk throughout Africa. In Nigeria, as in many countries of sub-Saharan Africa, it takes a terrible toll on human life and limb. Over the years, the news for those exposed to snake bite has been generally bad: withdrawal of antivenom manufacturers, increasing cost and, most recently, the marketing of ineffective or fake antivenoms in the region. Our paper reports encouraging results achieved by two antivenoms created as a direct consequence of the present crisis in antivenom supply for Africa. They have been assessed in the most powerful trial ever attempted in this field. The trial showed that in people with non-clotting blood following carpet viper bite, the commonest cause of snake bite morbidity and mortality in the West African savannah, administration of the antivenoms- EchiTAb G and EchiTAb Plus-ICP led to permanent restoration of blood clotting in 76% and 83% of the patients within 6 hours, respectively. Generally mild early adverse reactions were recorded in 19% and 26%, respectively. Both antivenoms proved effective and acceptably safe and can be recommended for treating carpet viper envenoming in Nigeria

Hepatitis c and Treatment

ABSTRACT Hepatitis C is a global epidemic that affects over 150 million people. The global prevalence of HCV infection is approximately 2.2 - 3% of the total population. This disease occurs mostly in parts of Africa and Central and East Asia. It is an infectious disease which is caused by a virus called HCV (Hepatitis C Virus) which can be transmitted either through blood or blood products, intravenous drug use, sexual transmission, sharp objects etc. Nowadays, Hepatitis C has become a curable disease with the development of new antiviral drugs which have been made to target more specific areas in the cells. There is almost a 90% cure rate with the use of the new oral direct acting viral drugs in circulation today as they have a more sustained viral response as compared to the previously used drugs. Before the availability of these drugs, the treatment was limited to the use of a combination of peg interferon and ribavirin which had a lower sustained viral response and a lot of side effects. With the advances in the field of medicine, physicians and researchers are still discovering newer therapies which can possibly lead to a 100% cure rate hopefully in a few years.egységes, osztatlanáltalános orvosango

Movilidad y vías de paso en los paisajes prehistóricos: megalitos y vías pecuarias en Almadén de la Plata (Sevilla, España)

De la larga tradición española sobre estudios del paisaje prehistórico, ha sido en los últimos treinta años que se han suscitado diversas teorías acerca de la función de los monumentos megalíticos y su asociación a otros ele-mentos integrales del paisaje como los caminos y vías pecuarias. Aunque la tradición trashumante y sus caminos se registran por primera vez hacia la Edad Media, observaciones en campo han señalado la coincidencia en mu-chos casos del trazado de las vías con la ubicación de monumentos megalíticos. Aunado a ello, se ha especula-do continuamente sobre las condiciones o variables que pudieron influenciar durante la Prehistoria Reciente el trazado de los caminos y la movilidad de estas sociedades. Distintos autores han sugerido que las vías pecuarias fueron trazadas tomando en cuenta diversas variables naturales y haciendo uso óptimo del terreno con respecto a tiempos de travesía, esfuerzo consumido, disponibilidad de recursos (como el agua) y otros factores sociales. El presente trabajo expone los resultados de diversos experimentos realizados entorno a la posible relación entre los monumentos megalíticos y las vías pecuarias en el municipio de Almadén de la Plata (Sevilla). Por medio de diversos análisis llevados cabo utilizando un Sistema de Información Geográfica (SIG) y métodos estadísticos, se ha investigado el grado de correlación entre estos elementos arqueológicos y se han realizado dos experimen-tos sobre movilidad en el paisaje, llevando a cabo el cálculo de caminos óptimos de la zona de Almadén de la Plata y comparando su coincidencia con las vías pecuarias registradas

Distribution of four <i>Echis</i> species in Africa and the Middle East.

<p>Key: <i>E. ocellatus</i> – blue, <i>E. pyramidum</i> – red, <i>E. coloratus</i> – green, <i>E. carinatus</i> – purple. Distributions mapped according to the WHO venomous snake distribution database and a recent study of the genus <i>Echis </i><a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000851#pntd.0000851-Pook1" target="_blank">[16]</a>, <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000851#pntd.0000851-WHO2" target="_blank">[35]</a>.</p

РАЗРАБОТКА САЙТА «ТОПОЛОГИЧЕСКИЕ ПРОСТРАНСТВА»

Venomic analysis of the venoms of Naja nigricollis, N. katiensis, N. nubiae, N. mossambica, and N. pallida revealed similar compositional trends. The high content of cytotoxins and PLA(2)s may account for the extensive tissue necrosis characteristic of the envenomings by these species. The high abundance of a type I α-neurotoxin in N. nubiae may be responsible for the high lethal toxicity of this venom (in rodents). The ability of EchiTAb-Plus-ICP antivenom to immunodeplete and neutralize the venoms of African spitting cobras was assessed by antivenomics and neutralization tests. It partially immunodepleted 3FTx and PLA(2)s and completely immunodepleted SVMPs and CRISPs in all venoms. The antivenom neutralized the dermonecrotic and PLA(2) activities of all African Naja venoms, whereas lethality was eliminated in the venoms of N. nigricollis, N. mossambica, and N. pallida but not in those of N. nubiae and N. katiensis. The lack of neutralization of lethality of N. nubiae venom may be of medical relevance only in relatively populous areas of the Saharan region. The impaired activity of EchiTAb-Plus-ICP against N. katiensis may not represent a major concern. This species is sympatric with N. nigricollis in many regions of Africa, although very few bites have been attributed to it

Extensive cross-specific immunological reactivity between <i>Echis</i> venoms and <i>Echis</i> species-specific IgG antisera revealed by End Point Titration ELISA.

<p>Venom from <i>E. ocellatus</i> (blue bars), <i>E. p. leakeyi</i> (red bars), <i>E. coloratus</i> (green bars) and <i>E. c. sochureki</i> (purple bars) were incubated with serial dilutions (horizontal axis) of IgG antisera raised against <i>E. ocellatus</i> (A), <i>E. p. leakeyi</i> (B), <i>E. coloratus</i> (C) and <i>E. c. sochureki</i> (D) and the optical density determined (vertical axis).</p

Venom affinity-chromatography to measure the binding strength of each <i>Echis</i> species-specific antisera to each venom.

<p>The amount of IgG from each <i>Echis</i> species specific antisera that remained bound to the <i>Echis</i> venom affinity chromatography column is displayed as a percent of the 3 mg of each IgG added to the column. Italicised values highlight homologous venom-antivenom results.</p

The End Point Titre of each <i>Echis</i> species-specific IgG antisera to each <i>Echis</i> venom.

<p>Italicised values highlight homologous combinations of venom-IgG antisera.</p

<i>Echis</i> species-specific IgG antisera exhibit extensive cross-specific venom protein reactivity.

<p>The venom proteins of <i>E. ocellatus (E.o)</i>, <i>E. p. leakeyi (E.p.l)</i>, <i>E. coloratus (E.c)</i> and <i>E. c. sochureki (E.c.s)</i> visualised using reduced SDS-PAGE (A), after immunoblotting, showed extensive cross-specific reactivity with IgG antisera specific to <i>E. ocellatus</i> (B), <i>E. p. leakeyi</i> (C), <i>E. coloratus</i> (D) <i>E. c. sochureki</i> (E). The sera were diluted 1∶5,000 and 7µg of each venom was used in all gels.</p