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Editorial [Hot Topic: Snakebite Management: Time For Strategic Approach (Guest Editor: K. Kemparaju)]

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Snakebite is a medical emergency and considered as an integral occupational hazard for farming and agricultural workers of the rural population worldwide. The human sufferings, morbidity and mortality rate is becoming increasingly high in South and Southeast Asian countries due to snakebite. Death or the physical deformities due to snakebite generally affects the young and healthy bread winners of the family that results in the devastating socio-economic balance. World Health Organization for the first time in 2009 declared snakebite as the neglected tropical disease. Although the available epidemiology data is highly elusive, a daunting value of about 5.5 million people is estimated to be affected by snakes, of which about 400000 amputations and between 20000 and 125 000 deaths each year.

Snakebite results in simultaneous lethal assault on vital functions including nervous, respiratory, cardiovascular and haemostatic functions. In addition, the bite in most cases causes intimidating necrosis at the bite site. Timely administration of the anti-venom by intravenous route is the effective and preferred therapy available as of now to save the victim. A range of antivenoms, monospecific, polyspecific, F(ab)2 and Fab are produced worldwide and all of them are found to be effective nearly to a similar extent. Serum sickness due to over dosage of foreign proteins and inability to protect local tissue degradation are the major limitations of this therapy. In several cases, persistent tissue necrosis even after successful neutralization of fatal systemic toxicity is a serious concern. This morbidity might lead to permanent disfigurement, crippling or amputation of the affected limb in a healthy individual. In the last 50 years of snake venom research, there has been a commendable achievement made towards understanding the structure-activity relationships of target specific toxins, exploring them as tools to understand many complicated mechanisms of Biology and to design lead therapeutics. Despite, studies' addressing the complications of snake bite therapy such as designing diagnostic kits to identify the bitten species, improving the efficacy of anti-venom therapy or inhibition of local toxicity has remained nearly stand still. Nonetheless, only a few studies are attempting to find new therapeutics from plants and snake plasma and also generated synthetic molecules that would complement the anti-venom therapy in better neutralization and management of both systemic and local toxicity of snakebite.

In contrast to the well understood systemic toxicity, the pharmacology of local toxicity (tissue destruction at the bitten region) is comparatively less understood. The latter is not usually associated with fatality, and this could be the reason for less interest shown. The local toxicity is characterized by edema, hemorrhage, blistering and dermo- and myonecrosis. In spite of myriad data on venom pharmacology, the precise molecular mechanism attributable for tissue necrosis is obscure and elusive. Although venom induced long term inflammatory response cannot be ignored, an array of hydrolytic enzymes including matrix degrading metalloproteases and hyaluronidases, phospholipases A2 and non-enzymatic myotoxins appears to be the key factors. It has generally conceived that the tissue damage at the bite site is associated with viperine and crotaline bites; however, several species of spitting cobra such as Naja asher, N. nigricollis, and N. siamensis also cause extensive tissue damage. In some cases, the venom is non-lethal but, cause violent local toxicity, for example, the Indian Trimeresurus malabaricus venom cause terrifying tissue necrosis at the site of injection. As of now, no remedial measures are available to treat such incidents. Thus, the snake bite (systemic and local toxicities) and its efficient management not only an issue of greater concern restricted to developing, tropical, subtropical or southeast Asian countries but, a global issue that needs special attention. Hence, there is an absolute demand for the culmination of research output from researchers and medical practitioners, who are directly or indirectly, associated with snakebite and its management worldwide. Thus, this special issue is focused on addressing some of the burning problems associated with snake bite, including long term complications and the possible therapeutics that might complement the anti-venom therapy which would enhance its efficacy and also effective management.

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Document Type: Research Article

Publication date: October 1, 2011

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