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Scott A Weinstein - One of the best experts on this subject based on the ideXlab platform.
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neurotoxicity with persistent unilateral ophthalmoplegia from envenoming by a wild inland taipan oxyuranus microlepidotus elapidae in remote outback south australia
Toxicon, 2017Co-Authors: Scott A Weinstein, Evan Everest, Jeremy Purdelllewis, Michael Harrison, Fiona Tavender, Sam Alfred, Liz Marrack, Chris Davenportklunder, Neralie WearnAbstract:Abstract Introduction A case of life threatening envenoming by a wild specimen of the inland taipan, Oxyuranus microlepidotus , is described. There have been 11 previously well-documented envenomings by O. microlepidotus, but only 2 were inflicted by wild snakes. Envenomed patients have presented predominantly with defibrinating coagulopathy and neurotoxicity. Case report The victim was seeking to observe members of an isolated population of this species and was envenomed while attempting to photograph an approximately 1.5 m specimen. He reported feeling “drowsiness” and blurred vision that progressed to ptosis; he later developed dysphagia and dysarthria. The patient was treated with 1 vial of polyvalent antivenom, which was later followed with an additional two vials of taipan monovalent. He was intubated during retrieval, and recovered after 3 days of intensive care. He had a right ophthalmoplegia that persisted for approximately 1 week post-envenoming. Despite a positive 20-min whole Blood Clotting Test, defibrination coagulopathy was absent, and there was no myotoxicity, or acute kidney injury. Discussion Physicians presented with a patient envenomed by O. microlepidotus should remain cognizant of the possible variability of medically important venom toxins in some populations of this species. Some patients seriously envenomed by this species may develop persistent cranial nerve palsies. When clinically indicated, prompt provision of adequate antivenom is the cornerstone of managing O. microlepidotus envenoming. Rapid application of pressure-bandage immobilization and efficient retrieval of victims envenomed in remote locales, preferably by medically well-equipped aircraft, probably improves the likelihood of a positive outcome.
Neralie Wearn - One of the best experts on this subject based on the ideXlab platform.
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neurotoxicity with persistent unilateral ophthalmoplegia from envenoming by a wild inland taipan oxyuranus microlepidotus elapidae in remote outback south australia
Toxicon, 2017Co-Authors: Scott A Weinstein, Evan Everest, Jeremy Purdelllewis, Michael Harrison, Fiona Tavender, Sam Alfred, Liz Marrack, Chris Davenportklunder, Neralie WearnAbstract:Abstract Introduction A case of life threatening envenoming by a wild specimen of the inland taipan, Oxyuranus microlepidotus , is described. There have been 11 previously well-documented envenomings by O. microlepidotus, but only 2 were inflicted by wild snakes. Envenomed patients have presented predominantly with defibrinating coagulopathy and neurotoxicity. Case report The victim was seeking to observe members of an isolated population of this species and was envenomed while attempting to photograph an approximately 1.5 m specimen. He reported feeling “drowsiness” and blurred vision that progressed to ptosis; he later developed dysphagia and dysarthria. The patient was treated with 1 vial of polyvalent antivenom, which was later followed with an additional two vials of taipan monovalent. He was intubated during retrieval, and recovered after 3 days of intensive care. He had a right ophthalmoplegia that persisted for approximately 1 week post-envenoming. Despite a positive 20-min whole Blood Clotting Test, defibrination coagulopathy was absent, and there was no myotoxicity, or acute kidney injury. Discussion Physicians presented with a patient envenomed by O. microlepidotus should remain cognizant of the possible variability of medically important venom toxins in some populations of this species. Some patients seriously envenomed by this species may develop persistent cranial nerve palsies. When clinically indicated, prompt provision of adequate antivenom is the cornerstone of managing O. microlepidotus envenoming. Rapid application of pressure-bandage immobilization and efficient retrieval of victims envenomed in remote locales, preferably by medically well-equipped aircraft, probably improves the likelihood of a positive outcome.
Geoffrey K Isbister - One of the best experts on this subject based on the ideXlab platform.
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performance of the 20 minute whole Blood Clotting Test in detecting venom induced consumption coagulopathy from russell s viper daboia russelii bites
Thrombosis and Haemostasis, 2017Co-Authors: Indira Ratnayake, Kalana Maduwage, Nicholas A Buckley, Fathima Shihana, Dhammika Menike Dissanayake, Geoffrey K IsbisterAbstract:The 20-minute whole Blood Clotting Test (WBCT20) is used as a bed-side diagnostic Test for coagulopathic snake envenoming. We aimed to assess the performance of the WBCT20 in diagnosis of venom induced consumption coagulopathy (VICC) in Russell’s viper envenoming. Adult patients admitted with suspected snake bites were recruited from two hospitals. WBCT20 and prothrombin time (PT) Test were performed on admission. WBCT20 was done by trained clinical research assistants using 1 ml whole Blood in a 5 ml borosilicate glass tube with a 10 mm internal diameter. The PT was measured by a semi-automated coagulation system and international normalised ratio (INR) calculated. VICC was defined as present if the INR was >1.4. The diagnostic utility of WBCT20 was determined by calculating the sensitivity and specificity of the WBCT20 on admission for detecting VICC. There were 987 snake bites where both WBCT20 and PT were done on admission samples. This included 79 patients (8 %) with VICC. The WBCT20 was positive in 65/79 patients with VICC (sensitivity 82 %; 95 % confidence interval [CI]: 72–90 %) and was falsely positive in 13/908 with no coagulopathy. The WBCT20 was negative in 895/908 snake bites with no coagulopathy (specificity: 98 % 95 % CI: 97–99 %) and was falsely negative in 14/79 with VICC. Using trained clinical staff, the WBCT20 Test had a relatively good sensitivity for the detection of VICC, but still missed almost one fifth of cases where antivenom was potentially indicated. Supplementary Material to this article is available online at www.thrombosis-online.com.
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diagnostic 20 min whole Blood Clotting Test in russell s viper envenoming delays antivenom administration
QJM: An International Journal of Medicine, 2013Co-Authors: Geoffrey K Isbister, Kalana Maduwage, Seyed Shahmy, Fahim Mohamed, Chandana Abeysinghe, Harindra Karunathilake, C A Ariaratnam, Nicholas A BuckleyAbstract:Background: The 20-min whole Blood Clotting Test (WBCT20) is widely used for the identification of coagulopathy in snake envenoming, but its performance in practice has not been evaluated. Aim: We aimed to investigate the diagnostic utility of the WBCT20 for coagulopathy in Russell’s viper envenoming. Design: Prospective observational study. Methods: Adult patients with snake envenoming were recruited. Age, sex, bite information, clinical effects, serial WBCT20 and antivenom treatment were recorded. Definite Russell’s viper envenoming was confirmed with venom specific enzyme immunoassay. We assessed sensitivity of admission WBCT20 to coagulopathy (international normalized ratio, INR > 1.5) in Russell’s viper envenoming, the specificity of negative WBCT20 in non-envenomed patients and directly compared paired WBCT20 and INR. Results: Admission WBCT20 was done in 140 Russell’s viper bites with coagulopathy and was positive in 56/140 [sensitivity 40% (95% confidence interval (CI): 32–49%)]. A negative WBCT20 led to delayed antivenom administration [WBCT20−ve Tests: median delay, 1.78 h (interquartile range (IQR): 0.83–3.7 h) vs. WBCT20 + ve Tests: median delay, 0.82 h (IQR: 0.58–1.48 h); P = 0.0007]. Delays to antivenom were largely a consequence of further WBCT20 being performed and more common if the first Test was negative (41/84 vs. 12/56). Initial WBCT20 was negative in 9 non-envenomed patients and 48 non-venomous snakebites [specificity: 100% (95% CI: 94–100%)]. In 221 paired Tests with INR > 1.5, the WBCT20 was positive in 91(41%). The proportion of positive WBCT20 only increased slightly with higher INR. Conclusions: In clinical practice, the WBCT20 has low sensitivity for detecting coagulopathy in snake envenoming and should not over-ride clinical assessment-based decisions about antivenom administration. There is an urgent need to develop a simple bedside Test for coagulopathy in snake envenoming.
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epidemiology and clinical effects of hump nosed pit viper genus hypnale envenoming in sri lanka
Toxicon, 2013Co-Authors: Kalana Maduwage, Geoffrey K Isbister, Anjana Silva, Sunil Bowatta, Suresh Mendis, Indika GawarammanaAbstract:Hump-nosed pit vipers of Genus Hypnale are the commonest cause of snake bite in Sri Lanka. Although there are many reports of local effects, coagulopathy and acute kidney injury, it remains unclear how frequent these clinical effects are and therefore the medical importance of this snake genus. The genus has been recently revised to include Hypnale hypnale from Sri Lanka and Western Ghats of Southern India, and the two endemic species to Sri Lanka, Hypnale zara and Hypnale nepa. This was a prospective hospital-based clinical study of definite Hypnale spp. bites from July 2008 to July 2010 in six Sri Lankan hospitals. There were 114 patients included and all snakes were correctly identified by hospital staff as Hypnale spp. Of these, 93 snakes were identified as H. hypnale by an expert, 16 as H. zara and five as H. nepa. Most bites occurred on the lower limbs in the daytime. There was no difference in the clinical effects between the three species. Pain and fang marks were present in all patients, 101 had local swelling and only 16 (14%) developed extensive local swelling that spread proximally and involved more than half of the bitten limb. Systemic symptoms occurred in 18 patients; four patients had an abnormal 20 min whole Blood Clotting Test and one patient developed an acute kidney injury that required haemodialysis. All patients were discharged alive with a median length of stay of 2 days. This study confirms that hump-nosed viper bites cause only minor effects in most cases. Future studies need to undertake formal coagulation studies and identify important early indicators of renal impairment.
Chris Davenportklunder - One of the best experts on this subject based on the ideXlab platform.
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neurotoxicity with persistent unilateral ophthalmoplegia from envenoming by a wild inland taipan oxyuranus microlepidotus elapidae in remote outback south australia
Toxicon, 2017Co-Authors: Scott A Weinstein, Evan Everest, Jeremy Purdelllewis, Michael Harrison, Fiona Tavender, Sam Alfred, Liz Marrack, Chris Davenportklunder, Neralie WearnAbstract:Abstract Introduction A case of life threatening envenoming by a wild specimen of the inland taipan, Oxyuranus microlepidotus , is described. There have been 11 previously well-documented envenomings by O. microlepidotus, but only 2 were inflicted by wild snakes. Envenomed patients have presented predominantly with defibrinating coagulopathy and neurotoxicity. Case report The victim was seeking to observe members of an isolated population of this species and was envenomed while attempting to photograph an approximately 1.5 m specimen. He reported feeling “drowsiness” and blurred vision that progressed to ptosis; he later developed dysphagia and dysarthria. The patient was treated with 1 vial of polyvalent antivenom, which was later followed with an additional two vials of taipan monovalent. He was intubated during retrieval, and recovered after 3 days of intensive care. He had a right ophthalmoplegia that persisted for approximately 1 week post-envenoming. Despite a positive 20-min whole Blood Clotting Test, defibrination coagulopathy was absent, and there was no myotoxicity, or acute kidney injury. Discussion Physicians presented with a patient envenomed by O. microlepidotus should remain cognizant of the possible variability of medically important venom toxins in some populations of this species. Some patients seriously envenomed by this species may develop persistent cranial nerve palsies. When clinically indicated, prompt provision of adequate antivenom is the cornerstone of managing O. microlepidotus envenoming. Rapid application of pressure-bandage immobilization and efficient retrieval of victims envenomed in remote locales, preferably by medically well-equipped aircraft, probably improves the likelihood of a positive outcome.
Jeremy Purdelllewis - One of the best experts on this subject based on the ideXlab platform.
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neurotoxicity with persistent unilateral ophthalmoplegia from envenoming by a wild inland taipan oxyuranus microlepidotus elapidae in remote outback south australia
Toxicon, 2017Co-Authors: Scott A Weinstein, Evan Everest, Jeremy Purdelllewis, Michael Harrison, Fiona Tavender, Sam Alfred, Liz Marrack, Chris Davenportklunder, Neralie WearnAbstract:Abstract Introduction A case of life threatening envenoming by a wild specimen of the inland taipan, Oxyuranus microlepidotus , is described. There have been 11 previously well-documented envenomings by O. microlepidotus, but only 2 were inflicted by wild snakes. Envenomed patients have presented predominantly with defibrinating coagulopathy and neurotoxicity. Case report The victim was seeking to observe members of an isolated population of this species and was envenomed while attempting to photograph an approximately 1.5 m specimen. He reported feeling “drowsiness” and blurred vision that progressed to ptosis; he later developed dysphagia and dysarthria. The patient was treated with 1 vial of polyvalent antivenom, which was later followed with an additional two vials of taipan monovalent. He was intubated during retrieval, and recovered after 3 days of intensive care. He had a right ophthalmoplegia that persisted for approximately 1 week post-envenoming. Despite a positive 20-min whole Blood Clotting Test, defibrination coagulopathy was absent, and there was no myotoxicity, or acute kidney injury. Discussion Physicians presented with a patient envenomed by O. microlepidotus should remain cognizant of the possible variability of medically important venom toxins in some populations of this species. Some patients seriously envenomed by this species may develop persistent cranial nerve palsies. When clinically indicated, prompt provision of adequate antivenom is the cornerstone of managing O. microlepidotus envenoming. Rapid application of pressure-bandage immobilization and efficient retrieval of victims envenomed in remote locales, preferably by medically well-equipped aircraft, probably improves the likelihood of a positive outcome.