bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health economics of snakebite envenomation: A sub-Saharan African perspective
Authors: Ayesiga Innocent , Gmanyami Jonathan Mawutor , Akaka Alex , Kubwimana Olivier , Ternor Joshua Naatey , Hashim Ukasha Musa , Gyabaah Gertrude Ahenewaa , Turzin Justice Kwadwo , Kahwa Ivan 
Published: January 2025

Abstract
Sub-Saharan Africa (SSA) is affected by the high direct and indirect costs of snakebite envenomation. With &gt;30% of global mortality, different economic barriers still exist, and effective strategies must be employed to avert the burden and promote quality of life. With the WHO target of reducing the number of snakebites by one-half by 2030, different aspects concerning snakebite envenomation economics must be evaluated, and potential strategies must be developed. Strategies such as exploring the different snakebite prevention interventions, and the costs associated with these interventions, must be prioritized through extensive research and targeted surveys. Information obtained from these surveys can be used to draft effective policies to minimize snakebite envenomation incidence, reduce the economic burden associated with envenomation and improve the quality of life of people at risk. In this narrative review, we evaluate the different aspects concerning the health economics of snakebite envenomation and explore the financial capacity of SSA countries to mitigate envenomation. Additionally, we propose multiple steps that could be undertaken to mitigate the financial burden of envenomation in SSA. Furthermore, we propose critical research strategies to minimize direct and indirect costs arising from snakebite envenomation in the region.
Medically important snakes in Sudan: an overview of distribution, clinical features and present challenges
Authors: Baleela Rania M H , Elamin Muhammad E M O , Mohammad Abubakr , Saeed Sara A K 
Published: January 2025

Abstract
Snakebite envenomation (SBE) is a neglected tropical disease. It causes substantial morbidity and mortality in Sudan. Despite its endemicity, there is a substantial lack of up-to-date data on venomous snakes and their geographical distribution in Sudan, with most information dating back to the early twentieth century. To address this gap, we conducted a narrative review of the literature on snakes and SBE in Sudan. This review involved systematic searches of databases, historical publications and online resources from 1908 to 2024. Integrating literature findings with personal field experiences to provide a comprehensive overview of the SBE situation in Sudan, we identified 19 medically significant snake species in Sudan from four families. These species exhibit a range of venom types and clinical effects, including neurotoxic, hemotoxic and cytotoxic envenomation. The most dangerous and important species are the carpet viper (Echis pyramidum), the Nubian cobra (Naja nubiae) and the Sudan burrowing asp (Atractaspis phillipsi). Challenges in snakebite management include the non-availability of specific antivenoms, inadequate healthcare infrastructure and reliance on traditional medicine. We recommend establishing a national snakebite registry, improving healthcare infrastructure, developing training programs for healthcare professionals and increasing public awareness. Strengthening international collaborations for antivenom production and investing in molecular research are also crucial for reducing the severity and associated morbidity of SBE in Sudan.
Health-seeking behaviours and traditional healer practices for snakebite in rural and tribal communities in southern India
Authors: Ralph Ravikar , Ramesh Rohan Michael , Jambugulam Mohan , Deborah Arpitha Anbu , Aruldas Kumudha , Moorthy Neal A , John Sushil Mathew , Walson Judd L , Zachariah Anand , Ajjampur Sitara Swarna Rao 
Published: January 2025

Abstract

Background
Nearly 60 000 Indians die of snakebite envenoming each year. Most deaths occur in rural communities and remote tribal settlements. We describe snakebite-related epidemiology and health-seeking behaviours in a rural (Timiri) and remote tribal block (Jawadhu Hills) in Tamil Nadu, India.

Methods
This cross-sectional survey used structured questionnaires for information pertaining to snakebites and their treatment in the preceding year. Treatment-seeking behaviour from the moment reported until recovery was mapped. Traditional healers residing in the two blocks were also surveyed.

Results
Snakebite incidence and mortality were 174/100 000 population and 2.7/100 000 population in Jawadhu Hills and 194/100 000 population and 2.6/100 000 population in Timiri, respectively. More snakebite victims applied tourniquets in Jawadhu Hills (90%) than in Timiri (69%). Traditional healers were the first contact for 64% in Jawadhu Hills. Ambulances and buses were reported as unavailable in Jawadhu Hills. Traditional healers in Jawadhu Hills did not refer snakebite victims to hospitals.

Conclusions
Three challenges to snakebite mitigation in Indian rural and tribal communities highlighted in this study are potentially harmful first aid, a disconnect between traditional healers and the public health system and a lack of emergency transport to health facilities. Addressing these challenges would necessitate community awareness, traditional healer engagement and improved means of public transportation.
Snakebite envenomation through a gender intersectionality lens in low- and middle-income countries
Authors: Ayesiga Innocent , Naggayi Shamim , Gmanyami Jonathan Mawutor , Akaka Alex , Kubwimana Olivier , Gyabaah Gertrude Ahenewaa , Katusiime Elizabeth , Hashim Ukasha Musa , Kahwa Ivan 
Published: January 2025

Abstract
Snakebite envenomation continues to affect lives globally, with &gt;1.2 million envenomations and approximately 120 000 annual mortalities. Unfortunately, low- and middle-income countries (LMICs) contribute to &gt;80% of these global statistics. With different targets set to minimize the impact of snakebite envenoming, such as halving the envenoming cases by 2030 from the World Health Organization (WHO), multiple initiatives are inevitable. Gender intersectionality and tropical disease research for infectious diseases of poverty, developed by the WHO, has championed the exploration of neglected diseases, stratifying them using gendered domains. However, minimal research using the gender intersectionality framework has been conducted to explore snakebite envenoming, especially among LMICs. Exploring snakebite envenomation through a gendered lens is critical in developing gender-specific interventions for the prevention and treatment of envenomation. This narrative review explores the available literature about snakebite envenomation in LMICs through a gender intersectionality lens. It provides insights into the existing gaps, especially regarding research using intersectionality frameworks and the gendered matrix. It further proposes avenues of research using these domains to understand snakebite envenomation, especially through the intersectionality lens.
Knowledge, perceptions and healthcare practices of communities for management of snakebites in Kamuli District, Eastern Uganda
Authors: Tusabe Joan , Muhoozi Michael , Kajungu Dan , Mukose Aggrey , Kasasa Simon , Sebina Kibira Simon Peter 
Published: January 2025

Abstract

Background
Snakebite is one of the neglected tropical diseases in Uganda affecting rural areas, especially during the rainy season. Households mainly rely on traditional remedies for management, which are not always effective, leading to disability and sometimes death. We explored the knowledge, perceptions and healthcare practices related to snakebites in Kamuli District.

Methods
We used the participatory research appraisal (PRA) method to conduct the study. Six PRA sessions were carried out in five purposively selected villages of Wankole subcounty, Kamuli District, as they reported a high number of snakebites. In addition, we conducted 15 in-depth interviews with current and past snakebite victims and 10 key informant interviews with professional healthcare providers and traditional healers. Audio files were transcribed and translated verbatim and data were analysed to identify themes. Analysis was conducted using ATLAS.ti version 8.0.

Results
Overall, the community considered snakebites a big problem that worsens during rainy seasons. Knowledge of snakebite management was inadequate. Perceptions about snakes and snakebites included snakes are related to traditions, ancestral spirits and witchcraft. Practices following snakebites included applying a tourniquet and the use of herbs, paraffin and a 500-shilling coin. Snakebites were associated with out-of-pocket expenditures and limited capacity to manage.

Conclusions
The study calls for policy changes to improve snakebite management in Eastern Uganda, highlighting gaps in knowledge and harmful practices. It emphasizes the need for health education and financial support for affected households. Collaboration between healthcare providers, traditional healers and the community is crucial for effective prevention and management.
Characteristics of snakebite patients due to Naja samarensis in the Philippines: a prospective hospital-based study
Authors: Aoki Yoshihiro , Paghubasan Jonathan , Tiglao Patrick Joseph , Sarmiento Marvin Jay , Arrieta Rustan , Tan Mariedel A , Sarsalijo Mardie S , Aquino Grace Joy B , Beronilla-Uraga Mercy Grace , Comandante John David L , Santamaria Emelia B , Malijan Greco Mark B , Suzuki Shuichi , Takahashi Kensuke , Yamano Shuhei , Smith Chris , Hayakawa Koichi , Tasaki Osamu , Agosto Lourdes C , Warrell David A , Ariyoshi Koya 
Published: January 2025

Abstract

Background
Little is known about snakebites by Naja samarensis, a species unique to the Philippines. The aim here is to describe the clinical and epidemiological characteristics of patients bitten by this medically important cobra in the Eastern Visayas.

Methods
A hospital-based prospective study analysed the features of snakebite patients attending Eastern Visayas Medical Center between June 2022 and May 2023. Logistic regression analysis identified the factors associated with severity.

Results
A total of 175 snakebite patients with five fatalities were included. Naja samarensis was most commonly implicated (n=49, 28.0%), although it could be definitively identified, by examining photographs of the snake responsible, in only four cases. The N. samarensis bites occurred in grass or rice fields, in daytime, and during farming activities, but the people bitten were most frequently students (34.7%) who were bitten at home (36.7%). Patients bitten by N. samarensis often presented with cytotoxic (63.3%) and neurotoxic signs (46.9%). Traditional remedies were common, resulting in delayed presentation to the hospital. Bites by N. samarensis, and older age (&gt;44 y) were independently associated with severity (adjusted OR of 10.33 and 7.89, respectively).

Conclusion
Naja samarensis is a major cause of severe snakebites in this region. Pre-hospital treatment frequently involves wasted time and unproven traditional methods. Enhancement of public awareness is urgently needed. Development of a diagnostic test for species identification is warranted to improve future surveys and management.
Antivenom ineffectiveness in Echis carinatus sochureki envenoming: a five-year, single-centre experience from India
Authors: Gopalakrishnan Maya , Kumar PH Akhilesh , Tanwar Divya , Bhat KS Samarth , Choudhary Bharat , Garg Mahendra K 
Published: January 2025

Abstract

Background
Snakebite is a neglected tropical disease that causes significant morbidity and mortality in India. In this study, we describe the clinical characteristics and outcomes of Echis carinatus sochureki envenoming from Western Rajasthan. We document the clinical ineffectiveness of the currently available Indian polyvalent antivenom in managing E. c. sochureki envenoming.

Methods
In this ambispective study, conducted from 14 April 2019 to 15 April 2024, we enrolled all patients presenting to our emergency department at a tertiary care centre in Jodhpur, Rajasthan, with a history of snakebite. After they provided informed consent, the demographic details, bite geo-location, bite-to-antivenom time, antivenom dose, coagulation profile, mortality and duration of hospital stay of those patients with E. c. sochureki envenoming were recorded.

Results
Of 210 patients screened, 105 had E. c. sochureki envenoming, 103 venom-induced consumption coagulopathy, 36 (34.3%) local bleeding and 55 (52.3%) systemic bleeding. The median bite-to-antivenom time was 2 (IQR: 1.13–4.0) h. The median antivenom dose was 22 (IQR: 10–30) vials. Of 92 patients who received antivenom, 63 (68.4%) were unresponsive. Total antivenom dose and geographical location (West zone) were significant predictors of antivenom unresponsiveness. Fifty-three of 70 patients (75.7%) had delayed hypofibrinogenaemia. The mean hospital stay was 8.3±7.1 d with nine (8.6%) mortalities.

Conclusions
Our study highlights the alarming finding of poor antivenom response to E. c. sochureki envenoming, with significant clinical bleeding and delayed coagulopathy. There is an urgent need for region-specific antivenom in Western India.
Clinico-epidemiological study of snakebite: an audit of 13 years of data from a community-based treatment centre in eastern Nepal
Authors: Manandhar Srista , Chhetri Sunit , Basnet Rohan , Gautam Arun , Bhattarai Urza , Uprety Manish , Sharma Aarjav , Gautam Ujwal , Bhushal Madhav , Sharma Sanjib Kumar 
Published: January 2025

Abstract

Background
Snakebite envenomation is a global public health concern, especially in tropical and subtropical regions. We describe the demography, presentations, treatments and outcomes of snakebites from a community snakebite treatment centre in Nepal.

Methods
This was a retrospective study of snakebite cases from 2008 to 2021 presenting in a community-based treatment centre in eastern Nepal. The data were collected from predesigned forms in the centre.

Results
The median age of the victims (N=13 825) was 29 y (interquartile range 18–43) predominantly comprising farmers (39.5%). Cobras (Naja spp.) were the predominant species. Self-treatment practices like the application of tourniquets are common (74.5%) and antivenom was infused to 3.3% of victims. Motorcycles (57.9%) were the primary mode of transport, significantly reducing the time to reach healthcare centres compared with other means (p&lt;0.001). The majority of patients visiting the community snakebite centre exhibited improvement (98.4%), with a low referral rate (0.6%) and case fatality rate (1.26%).

Conclusions
Snakebites are a common problem in rural Nepal. Neurotoxic envenomation, inflicted by the common cobra, predominates in this area. This community-based snakebite treatment centre, managed by paramedics, exemplifies the successful outcome of snakebite management in Nepal.
Snake envenomation in Florida: a 20-year analysis of epidemiology and clinical outcomes at a tertiary medical centre
Authors: Grace River C , Leonard Waverly , Zawoy Maggie , Beatty Norman L 
Published: January 2025

Abstract

Background
Venomous snakes are among the most lethal animals worldwide and envenomation survivors face lifelong morbidities. Envenomation is colloquially considered highly prevalent in the US state of Florida, yet envenomation trends here are currently unassessed.

Methods
We present a comprehensive analysis of causes, characteristics and treatments of Florida's snake envenomations via medical records review of envenomated patients presenting to a major academic medical centre between 2002 and 2022.

Results
Envenomation occurred predominantly in adult men when handling wild snakes. The major envenomating species were the pygmy rattlesnake (Sistrurus miliarius) and cottonmouth (Agkistrodon piscivorus), and most patients were bitten on their hand/finger. Oedema, paraesthesia and nausea were typical, although life-threatening symptoms presented in some after envenomation by the timber rattlesnake (Crotalus horridus) and eastern diamondback rattlesnake (Crotalus adamanteus). After being bitten, 10% of patients attempted contraindicated self-treatments. Although 2.03 h elapsed prior to patients encountering a healthcare provider, there was no correlation between patients’ distance from the hospital and their time until arrival. An additional 4.22 h elapsed prior to administration of antivenom, and three patients died during hospitalization.

Conclusions
Many envenomations were preventable incidents caused by intentional engagement with wild snakes. Education regarding avoidance of venomous snakes and seeking immediate medical care may reduce the prevalence and morbidity of future envenomations.
Health literacy among the rural Bangladeshi population on first aid measures and prevention of snakebite
Authors: Farheen Chowdhury , Rahman A K M F , Ghose Aniruddha , Amin Md R , Rahman Abu S M M , Sayeed Abdullah A , Rahaman F M A , Howlader Chinmaya , Khan Sayra , Rashid Rumana , Chowdhury Nusaer , Debi Geeta R , Rahman Md Sahidur , Faiz M A 
Published: January 2025

Abstract

Background
Bangladesh has a high rate of snakebite. In rural areas, there is a significant mortality and morbidity rate due to lack of awareness and inappropriate first aid practices. This study aims to determine the knowledge and practices of the rural population in two subdistricts of Bangladesh regarding snakebite prevention and first aid measures.

Methods
This cross-sectional survey is part of an intervention study that was carried out in 250 randomly selected primary sampling units of Shibganj in the Chapainawabganj district and Kalapara in the Patuakhali district of Bangladesh. We enrolled a total of 2954 participants. The practice and knowledge were regarded adequate when the score exceeded 50%. We conducted a binomial logistic regression to identify the factors associated with inadequate knowledge and practice.

Results
The community's knowledge (15.9%) and practice (14.5%) regarding snakebite prevention was insufficient. More than 77% and 45.4% of respondents believed that applying a tourniquet above the bite site and seeking a traditional healer after a snakebite were effective first aid measures. Poor knowledge was more likely to occur in farming, fishing, homemaker groups and those with lower incomes (11 000–24 000 Bangladeshi taka). Negative practices were associated with females and high family income.

Conclusions
This study highlights the necessity of community intervention, with a focus on appropriate first aid and prevention measures through widespread education.
The Importance of Sexual History-Taking Within Surgery
Authors: Chinn Justine O. , Hawn Mary T. 
Published: January 2025

Abstract
Sexual and reproductive health is an essential part of comprehensive medical care. As the field of medicine becomes more specialized and siloed and the diagnostic work-up in surgery more advanced, the risk of anchoring diagnoses and partitioning of care increases. Thus, the fundamentals of a complete patient history and review of each body system remain critical in ensuring that surgeons establish a broad differential diagnosis; provide comprehensive, well-rounded care to patients; and create opportunities for patient counseling and interventions. The article by Coleman and colleagues reports on an intervention that did not result in trainees being more likely to take a sexual history; however, the intervention group did ask significantly more questions regarding sexual health than the comparison group when they did take a sexual history. They highlight that there is a persistent gap in sexual history-taking, and that this results in potential misdiagnoses as well as missed opportunities to counsel patients about sexual and reproductive health. Clinicians have a responsibility to recognize factors that increase risk for their patients and provide appropriate counseling, which they cannot do if they are not asking all the necessary questions, even the difficult ones.
Integrated psychosocial support in the ICU
Authors: Rose Matthias , Schürmann Katrin , Ferentzi Hannah , Schmitt Katharina R.L. 
Published: January 2025

Purpose of review
During treatment in the ICU, patients, relatives, as well as staff members are exposed to a variety of potentially traumatic experiences. The study explores current concepts to prevent negative effects on mental health resulting from intensive care treatment.

Recent findings
Most healthcare systems rely on consultation or liaison services to address mental health issues provided by mental health experts based outside of the ICU. Those services usually react to manifest comorbid mental conditions, but are less effective to prevent mental health issues. Integrated psychosocial support (IPS) models acknowledge the fact that psychosocial demands are inherent to ICU treatment rather than an individual concern. First experiences support the assumption that clinical psychologists embedded within the ICU team effectively address the need of early identification of mental health issues, and are able to intervene timely and appropriately to traumatic events on the unit. They professionalize psychosocial support structures and facilitate low-threshold support for team members.

Summary
Psychologists integrated in the ICU team can effectively target psychosocial needs of patients and relatives with varying complexity. They support the ICU team by taking on those tasks, and contribute to the overall resilience of the ICU team and its members.
Study on the effect of full body isometric resistance training on cardiovascular pressure response
Authors: Zhang Tingran , Yang Yi , Wang Kun , Liu Shiqi , Luo Jiong 
Published: January 2025

Background and aims:
Exploring the effect of different isometric resistance training (IRT) on improving blood pressure, so as to provide important reference for the design of aerobic exercise prescription for IRT to improve blood pressure.

Methods:
Forty eight overweight or obese college students with irregular exercise habits were randomly divided into four groups and underwent exercise intervention three times a week for a total of 6 weeks. Cardiovascular changes were evaluated before the first and 18th exercise sessions, as well as 0, 30, and 60 min after exercise.

Results:
Heart rate (HR) of equal distance wall squat group (ISG) and whole body equal length exercise group (WIG) increased significantly immediately after exercise, but long-term IRT intervention significantly decreased systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) of WIG and ISG, SBP, and MAP of equal grip strength group (IHG), and DBP and MAP of equal curl up group (ICG); In the first exercise, ICG, ISG, and WIG significantly increased SBP and DBP immediately after exercise, ISG significantly increased MAP immediately after exercise, while in the 18th exercise, IHG, ISG, and WIG significantly increased SBP immediately after exercise, ISG significantly increased DBP and MAP immediately after exercise.

Conclusion:
IRT is a safe and easy to implement exercise mode. Long-term intervention can effectively control blood pressure, and will not cause excessive cardiovascular pressure response after a single exercise.