https://ogma.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:51237 Wed 28 Feb 2024 16:07:34 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:45238 Wed 26 Oct 2022 19:41:16 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:45084 Wed 26 Oct 2022 14:04:08 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:50267 Wed 12 Jul 2023 12:12:15 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14464 14 y) with snake envenoming in Sri Lanka. Snake identification was by patient or hospital examination of dead snakes when available and confirmed by enzyme-immunoassay for Russell’s viper envenoming. Patients were blindly allocated in a 11 randomisation schedule to receive antivenom either as a 20 minute infusion (rapid) or a two hour infusion (slow). The primary outcome was the proportion with severe systemic hypersensitivity reactions (grade 3 by Brown grading system) within 4 hours of commencement of antivenom. Secondary outcomes included the proportion with mild/moderate hypersensitivity reactions and repeat antivenom doses. Of 1004 patients with suspected snakebites, 247 patients received antivenom. 49 patients were excluded or not recruited leaving 104 patients allocated to the rapid antivenom infusion and 94 to the slow antivenom infusion. The median actual duration of antivenom infusion in the rapid group was 20 min (Interquartile range[IQR]:20–25 min) versus 120 min (IQR:75–120 min) in the slow group. There was no difference in severe systemic hypersensitivity reactions between those given rapid and slow infusions (32% vs. 35%; difference 3%; 95%CI:−10% to +17%;p = 0.65). The frequency of mild/moderate reactions was also similar. Similar numbers of patients in each arm received further doses of antivenom (30/104 vs. 23/94). Conclusions: A slower infusion rate would not reduce the rate of severe systemic hypersensitivity reactions from current high rates. More effort should be put into developing better quality antivenoms.]]> Wed 11 Apr 2018 16:21:45 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:29575 Wed 11 Apr 2018 15:46:56 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:21003 Wed 11 Apr 2018 14:29:48 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:9557 Wed 11 Apr 2018 13:57:21 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14862 Wed 11 Apr 2018 13:51:59 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14472 Wed 11 Apr 2018 13:49:04 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14541 Wed 11 Apr 2018 13:36:43 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14410 Wed 11 Apr 2018 12:23:20 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14481 Wed 11 Apr 2018 12:14:17 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14507 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.]]> Wed 11 Apr 2018 11:31:16 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14545 Wed 11 Apr 2018 10:59:06 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14540 Wed 11 Apr 2018 10:55:00 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:50852 18y) from the Anuradhapura snakebite cohort were reviewed: Group I had a snakebite during August 2013-October 2014 and was reviewed after 4 years, and group II had a snakebite during May 2017-August 2018, and was reviewed after one year. Patients were invited by telephone, by sending let-ters, or doing home visits, including 199 of 736 patients (27%) discharged alive from group I and 168 of 438 patients (38%) from group II, a total of 367 followed up. Health effects were categorised as musculoskeletal, impact on daily life, and medically unexplained. Health issues were attributed to snakebite in 107/199 patients (54%) from group I and 55/168 patients (33%) from group II, suggesting the proportion with health issues increases with time. Sixteen patients (all viperine bites) had permanent musculoskeletal problems, none with a significant functional disability affecting daily routine. 217/367 reported being more vigilant about snakes while working outdoors, but only 21/367 were using protective foot-wear at review. Of 275 farmers reviewed, only six (2%) had restricted farming activities due to fear of snakebite, and only one stopped farming. 104/199 (52%) of group I and 42/168 (25%) of group II attributed non-specific symptoms (fatigue, body aches, pain, visual impairment) and/or oral cavity-related symptoms (avulsed teeth, loose teeth, receding gums) to the snakebite, which cannot be explained medically. In multivariate logistic regres-sion, farming, type of snake, antivenom administration, and time since snakebite were associated with medically unexplained symptoms. The latter suggests medically unexplained effects increased with time. Based on two groups of snakebite patients reviewed one and four years post-bite, we show that long-term musculoskeletal disabilities are uncommon and not severe in snakebite survivors in rural Sri Lanka. However, a large portion of patients complain of various non-specific general and oral symptoms, not explainable based on the known pathophysiology of snakebite. These perceived effects of snakebite were more common in patients with systemic envenoming, and were more frequent the longer the time post-bite.]]> Wed 09 Aug 2023 09:45:26 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20168 Tue 24 Aug 2021 14:23:24 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:44618 Tue 18 Oct 2022 08:58:32 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:41985 Tue 16 Aug 2022 15:55:22 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:43153 Tue 13 Sep 2022 15:28:50 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:51646 Tue 12 Sep 2023 20:13:50 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14861 Thu 28 Aug 2014 12:16:27 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:37720 Thu 25 Mar 2021 11:51:59 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:38989 Python molurus), and one viperid (Trimeresurus trigonocephalus). The snake species that caused the most-number of bites was the Trinket snake (Coelognathus helena) (n = 15). Three species of wolf-snakes, Lycodon aulicus, L. anamallensis, and L. striatus were responsible for 12, 11, and 5 bites respectively. Most of the patients (55%) presented to the local hospital and subsequently transferred to the study hospital for further management. None of the patients developed systemic envenoming and five developed mild local pain and swelling. Fifty-six (74%) patients were discharged on the following day, while 18 (24%) were discharged on the third day. There is a need to educate medical personnel working the peripheral hospital on how to identify medically lesser important snakes to avoid unnecessary transfers.]]> Thu 24 Aug 2023 09:10:48 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:39298 Thu 16 Nov 2023 12:19:07 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:50904 Thu 10 Aug 2023 13:31:43 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:35056 Thu 09 Dec 2021 11:01:32 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14441 Sat 24 Mar 2018 08:21:00 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:14463 25 kDa. All venoms (10 μg/ml) demonstrated in vitro neurotoxicity in the chick biventer cervicis nerve-muscle preparation, with a relative rank order of: H. signata ≥ D. devisi ≥ V. annulata = E. curta > C. boschmai. CSL polyvalent antivenom neutralized the inhibitory effects of C. boschmai venom but only delayed the inhibitory effect of the other venoms. All venoms displayed PLA2 activity but over a wide range (i.e. 1–621 μmol/min./mg). The venoms of C. boschmai (60 μg/kg, i.v.), D. devisi (60 μg/kg, i.v.) and H. signata (60 μg/kg, i.v.) produced hypotensive effects in vivo in an anaesthetized rat preparation. H. signata displayed moderate pro-coagulant activity while the other venoms were weakly pro-coagulant. This study demonstrated that these understudied Australian elapids have varying pharmacological activity, with notable in vitro neurotoxicity for four of the venoms, and may produce mild to moderate effects following systemic envenoming.]]> Sat 24 Mar 2018 08:19:17 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:10950 Sat 24 Mar 2018 08:14:16 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:10953 1.2 (abnormal) on admission, and the remaining 28 had an INR > 1.2 within 12 hours of the bite. Of 33 patients with myotoxicity, a combination of CK > 250 U/L and an abnormal aPTT identified all but two cases by 12 hours; one of these two was identified within 12 hours by leukocytosis. Nine cases of isolated neurotoxicity had a median time of onset after the bite of 4 hours (range, 35 min - 12 h). The combination of serial INR, aPTT and CK tests and repeated neurological examination identified 213 of 222 severe envenoming cases (96%) by 6 hours and 238 of 240 (99%) by 12 hours. Conclusion: Laboratory parameters (INR, aPTT and CK) and neurological reassessments identified nearly all severe envenoming cases within 12 hours of the bite, even in this conservative analysis that assumed normal test results if the test was not done.]]> Sat 24 Mar 2018 08:14:15 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:44915 Mon 24 Oct 2022 16:24:41 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:44856 Mon 24 Oct 2022 11:02:40 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:32502 4h. Median peak venom concentration in 25 patients with systemic envenoming and a sample available was 8.4ng/L (1-3212 ng/L). No venom was detected in post-antivenom samples, including 20 patients given one vial initially and five patients bitten by inland taipans. Discussion: Australian taipan envenoming is characterised by neurotoxicity, myotoxicity, coagulopathy, acute kidney injury and thrombocytopenia. One vial of antivenom binds all measurable venom and early antivenom was associated with a favourable outcome.]]> Mon 23 Sep 2019 13:46:15 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:31382 Mon 23 Sep 2019 11:16:26 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:49547 1000 U/L). Snake species was determined by expert identification or venom specific enzyme immunoassay. Analysis included patient demographics, clinical findings, pathology results, treatment and outcomes (length of hospital stay, complications). Results: 1638 patients were recruited January 2003–December 2016, 935 (57%) were envenomed, 148 developed myotoxicity (16%). Snake species most commonly associated with myotoxicity were Notechis spp. (30%), Pseudechis porphyriacus (20%) and Pseudechis australis (13%). Bite site effects occurred in 19 patients. Non-specific systemic symptoms occurred in 135 patients (91%), specific signs and symptoms in 83. In 120 patients with early serial CK results, the median peak CK was 3323 U/L (IQR;1050–785100U/L), the median time to first CK >500 U/L was 11.1 h and median time to peak CK of 34.3 h. White cell count was elevated in 136 patients (93%; median time to elevation, 4.9 h). 37 patients had elevated creatinine, six were dialysed. Two patients died from complications of severe myotoxicity. Antivenom given before the first abnormal CK (>500 U/L) was associated with less severe myotoxicity (2976 versus 7590 U/L). Non-envenomed patients with elevated CK had rapid rise to abnormal CK (median 3.5 h) and less had elevated WCC (32%). Conclusion: Myotoxicity from Australian snakes is relatively common and has systemic effects, with significant associated morbidity and mortality. CK is not a good early biomarker of mytoxicity. Early antivenom may play a role in reducing severity.]]> Mon 22 May 2023 08:45:05 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:42371 Mon 22 Aug 2022 14:22:32 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:39103 Mon 09 May 2022 15:34:40 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:45353 1.0% schistocytes on blood film examination, together with absolute thrombocytopenia (<150 x 10⁹ /L) or a relative decrease in platelet count of >25% from baseline. Patients are at risk of long-term chronic kidney disease and long term follow up is recommended.]]> Fri 28 Oct 2022 12:03:47 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:31503 Fri 22 Apr 2022 10:23:28 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:53857 Fri 19 Jan 2024 12:31:10 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:37583 16 years), who presented with a confirmed snakebite from August 2013 to October 2014 were recruited from Anuradhapura Hospital. Demographic data, information on the circumstances of the bite, first aid, health-seeking behaviour, hospital admission, clinical features, outcomes and antivenom treatment were documented prospectively. There were 742 snakebite patients [median age: 40 years (IQR:27–51; males: 476 (64%)]. One hundred and five (14%) patients intentionally delayed treatment by a median of 45min (IQR:20-120min). Antivenom was administered a median of 230min (IQR:180–360min) post-bite, which didn’t differ between directly admitted and transferred patients; 21 (8%) receiving antivenom within 2h and 141 (55%) within 4h of the bite. However, transferred patients received antivenom sooner after admission to Anuradhapura hospital than those directly admitted (60min [IQR:30-120min] versus 120min [IQR:52-265min; p<0.0001]). A significantly greater proportion of transferred patients had features of systemic envenoming on admission compared to those directly admitted (166/212 [78%] versus 5/43 [12%]; p<0.0001), and had positive clotting tests on admission (123/212 [58%] versus 10/43 [23%]; p<0.0001). Sri Lankan snakebite patients present early to hospital, but there remains a delay until antivenom administration. This delay reflects a delay in the appearance of observable or measurable features of envenoming and a lack of reliable early diagnostic tests. Improved early antivenom treatment will require reliable, rapid diagnostics for systemic envenoming.]]> Fri 19 Feb 2021 15:58:55 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:49785 10,000 U/L)]. The odds of (mild or severe) myotoxicity was lower in patients that received early antivenom (within 6 hours post-bite) compared to those that received late or no antivenom (odd ratio was 0.186; 95% confidence interval, 0.052–0.664). A population pharmacokinetic-pharmacodynamic (PKPD) model was developed to describe the relationship between the time course of venom (a mixture of toxins) and effect (elevated CK). In addition, a kinetic-pharmacodynamic (KPD) model was developed to describe the relationship between time course of a theoretical toxin and effect. Model development and parameter estimation was performed using NONMEM v7.3. No single set of parameter values from either the PKPD or KPD models were found that could accurately describe the time course of different levels of severity of myotoxicity. The predicted theoretical toxin half-life from the KPD model was 11 ± 3.9 hours compared to the half-life of venom of 5.3 ± 0.36 hours. This indicates that the putative causative toxin’s concentration-time profile does not parallel that of venom. Conclusion: Early antivenom administration reduces the incidence of myotoxicity. The venom concentration profile does not appear to be the driver for myotoxicity following envenomation. Additional factors that affect the sensitivity of the patient to snake venom/toxins must be explored to understand the relationship with myotoxicity.]]> Fri 02 Jun 2023 17:21:37 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:51341 1.5 (Incomplete VICC = INR>1.5 and complete VICC = ≥3.0). Results: A total of 272 confirmed snakebites (Russell’s viper[76], hump-nosed viper[89], non-venomous snakes[51] and unidentified bites[56]) were recruited (median age: 42 y [interquartile range: 30- 53 y]; 189 males [69%]). On admission, 82 (30%) had incomplete VICC (INR >1.5 and <3) and 77 (28%) had complete VICC (INR ≥3). Sixteen (6%) developed clinically apparent bleeding. The WBCT-15 had the best sensitivity of 47% for detecting VICC and 68% for complete VICC. The sensitivities of the WBCT-20, WBCT-25, CBCT-5 and CBCT-10 was 30–35%. The sensitivities of all tests were better in detecting complete VICC, VICC in Russell’s viper bites and more than 2 h post-bite. The WBCT-15 test had a sensitivity of 76% for VICC in confirmed Russell’s viper bites. For detection of VICC, CBCT-t had an an excellent sensitivity of 97%, but a poor specificity of 35% for an optimal cut-off of >6.25 min. Conclusion: WBCTs are poorly diagnostic for VICC in Russell’s viper and hump-nosed viper envenoming, missing up to two-thirds of patients for some tests. The WBCT-15 was the best test, improving for more severe VICC and greater than 2 h post-bite.]]> Fri 01 Sep 2023 13:35:05 AEST ]]>