Toxicon: X最新文献

{"title":"Multifaceted community health education programs as powerful tools to mitigate snakebite-induced deaths, disabilities, and socioeconomic burden","authors":"Sakthivel Vaiyapuri ,&nbsp;Priyanka Kadam ,&nbsp;Gnaneswar Chandrasekharuni ,&nbsp;Isadora S. Oliveira ,&nbsp;Subramanian Senthilkumaran ,&nbsp;Anika Salim ,&nbsp;Ketan Patel ,&nbsp;Jacqueline de Almeida Gonçalves Sachett ,&nbsp;Manuela B. Pucca","doi":"10.1016/j.toxcx.2022.100147","DOIUrl":"10.1016/j.toxcx.2022.100147","url":null,"abstract":"<div><p>Snakebite envenoming (SBE) predominantly affects rural impoverished communities that have limited access to immediate healthcare. These communities often hold numerous myths/misbeliefs about snakes and SBE. Moreover, healthcare professionals who practice in rural regions often work in unstable situations with limited medical infrastructure and therefore, lack sufficient knowledge/experience and confidence in the clinical management of SBE. Due to the lack of reliable statistics on the true burden of SBE, developing health policies for this condition by relevant authorities may be difficult. Hence, it is critical to improve awareness about SBE among rural communities, healthcare professionals and health authorities using robust multifaceted community health education approaches. Here, we describe the design, development, implementation, and impact of distinctive community health education approaches that we used in India and Brazil. A wide range of educational tools including information leaflets, posters, pocket guides, learning materials for healthcare professionals and short/long video documentaries were developed in local languages and used to engage with target communities through direct assemblies as well as mass/traditional and social media. Notably, we used diverse methods to determine the impact of our programs in improving awareness, treatment-seeking behaviour, and clinical practice. The people-centred approaches that we used were inclusive and highly impactful in instigating fundamental changes in the management of SBE among rural communities. The resources and approaches presented in this article can be easily adapted for wider use in other countries in order to collectively reduce SBE-induced deaths, disabilities and socioeconomic ramifications.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"17 ","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9827049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9160878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on snakebite envenoming care needs across different sociocultural contexts and health systems: A comparative qualitative analysis among US and Brazilian health providers","authors":"Eleanor Strand ,&nbsp;Felipe Murta ,&nbsp;Anna Tupetz ,&nbsp;Loren Barcenas ,&nbsp;Ashley J. Phillips ,&nbsp;Altair Seabra Farias ,&nbsp;Alícia Cacau Santos ,&nbsp;Gisele dos Santos Rocha ,&nbsp;Catherine A. Staton ,&nbsp;Flávia Regina Ramos ,&nbsp;Vinícius Azevedo Machado ,&nbsp;Fan Hui Wen ,&nbsp;João R.N. Vissoci ,&nbsp;Jacqueline Sachett ,&nbsp;Wuelton Monteiro ,&nbsp;Charles J. Gerardo","doi":"10.1016/j.toxcx.2022.100143","DOIUrl":"10.1016/j.toxcx.2022.100143","url":null,"abstract":"<div><p>With the advancements in therapeutics and available treatment options, almost all deaths and permanent disabilities from snakebite envenoming (SBE) are preventable. The challenge lies in implementing these evidence-based treatments and practices across different settings and populations. This study aims to compare data on provider perceptions of SBE care across health systems and cultural contexts to inform potential implementation science approaches. We hypothesize different health systems and cultural contexts will influence specific perceived needs to provide adequate snakebite care within central tenets of care delivery (e.g., cost, access, human resources). We previously conducted exploratory descriptive studies in the US and Brazil in order to understand the experience, knowledge, and perceptions of health professionals treating SBE. In the US, in-depth interviews were performed with emergency physicians from January 2020 to March 2020. In BR, focus group discussions were conducted with health professionals from community health centers at the end of June 2021. The focus group discussions (BR) were originally analyzed through an inductive thematic analysis approach. We conducted a secondary qualitative analysis in which this codebook was then applied to the interviews (US) in a deductive content analysis. The analysis concluded in August 2022. Brazil participants were physicians (n=5) or nurses (n=20) from three municipalities in the State of Amazonas with an average of three years of professional experience. US participants were emergency physicians (n=16) with an average of 15 years of professional experience. Four main themes emerged: 1) barriers to adequate care on the patient and/or community side and 2) on the health system side, 3) perceived considerations for how to address SBE, and 4) identified needs for improving care. There were 25 subthemes within the four themes. These subthemes were largely the same across the Brazil and US data, but the rationale and content within each shared subtheme varied significantly. For example, the subtheme “role of health professionals in improving care” extended across Brazil and the US. Brazil emphasized the need for task-shifting and -sharing amongst health care disciplines, whereas the US suggested specialized approaches geared toward increasing access to toxicologists and other referral resources. Despite similar core barriers to adequate snakebite envenoming care and factors to consider when trying to improve care delivery, health professionals in different health systems and sociocultural contexts identified different needs. Accounting for, and understanding, these differences is crucial to the success of initiatives intended to strengthen snakebite envenoming care. Implementation science efforts, with explicit health professional input, should be applied to develop new and/or adapt existing evidence-based treatments and practices for SBE.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"17 ","pages":"Article 100143"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/52/ed/main.PMC9791583.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10451642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathological, ultrastructural, and biochemical traits of apoptosis induced by peroxisomicine A1 (toxin T-514) from Karwinskia parvifolia in kidney and lung","authors":"Adolfo Soto-Domínguez ,&nbsp;Daniel Salas-Treviño ,&nbsp;Gloria A. Guillén-Meléndez ,&nbsp;Uziel Castillo-Velázquez ,&nbsp;Raquel G. Ballesteros-Elizondo ,&nbsp;Carlos R. Montes-de-Oca-Saucedo ,&nbsp;Sheila A. Villa-Cedillo ,&nbsp;Rodolfo Morales-Ávalos ,&nbsp;Luis E. Rodríguez-Tovar ,&nbsp;Roberto Montes-de-Oca-Luna ,&nbsp;Odila Saucedo-Cárdenas","doi":"10.1016/j.toxcx.2022.100148","DOIUrl":"https://doi.org/10.1016/j.toxcx.2022.100148","url":null,"abstract":"<div><p>Peroxisomicine A1 (PA1) is a toxin isolated from the <em>Karwinskia</em> genus plants whose target organs are the liver, kidney, and lung. <em>In vitro</em> studies demonstrated the induction of apoptosis by PA1 in cancer cell lines, and <em>in vivo</em> in the liver. Apoptosis has a wide range of morphological features such as cell shrinkage, plasma membrane blistering, loss of microvilli, cytoplasm, and chromatin condensation, internucleosomal DNA fragmentation, and formation of apoptotic bodies that are phagocytized by resident macrophages or nearby cells. Early stages of apoptosis can be detected by mitochondrial alterations. We investigated the presence of apoptosis <em>in vivo</em> at the morphological, ultrastructural, and biochemical levels in two target organs of PA1: kidney and lung. Sixty CD-1 mice were divided into three groups (n = 20): untreated control (ST), vehicle control (VH), and PA1 intoxicated group (2LD50). Five animals of each group were sacrificed at 4, 8, 12, and 24 h post-intoxication. Kidney and lung were examined by morphometry, histopathology, ultrastructural, and DNA fragmentation analysis. Pre-apoptotic mitochondrial alterations were present at 4 h. Apoptotic bodies were observed at 8 h and increased over time. TUNEL positive cells were detected as early as 4 h, and the DNA ladder pattern was observed at 12 h and 24 h. The liver showed the highest value of fragmented DNA, followed by the kidney and the lung. We demonstrated the induction of apoptosis by a toxic dose of PA1 in the kidney and lung <em>in vivo</em>. These results could be useful in understanding the mechanism of action of this compound at toxic doses <em>in vivo</em>.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"17 ","pages":"Article 100148"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50170900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and enablers of community engagement practices for the prevention of snakebite envenoming in South Asia: A qualitative exploratory study","authors":"N.J. Ten Have ,&nbsp;Gaby I. Ooms ,&nbsp;Benjamin Waldmann ,&nbsp;Tim Reed","doi":"10.1016/j.toxcx.2022.100144","DOIUrl":"10.1016/j.toxcx.2022.100144","url":null,"abstract":"<div><p>Snakebite envenoming (SBE) is a grossly neglected tropical disease (NTD) that predominantly affects those living in rural settings in low-and-middle income countries. South Asia currently accounts for the highest global SBE-related mortality, and substantial morbidity rates. To alleviate the high burden in the region, community engagement (CE) is considered to be an integral component for optimizing SBE prevention and control. To better understand existing CE practices for SBE in the region, the experiences of SBE-CE actors concerning the barriers to, and enablers of CE practices were captured through semi-structured interviews. Fifteen key informants from India, Bangladesh and Nepal participated in the study. Important enablers included providing innovative, inclusive and continuous methods and materials, carefully planning of programs, performing monitoring and evaluation, SBE data availability, motivated and trained staff members, good organizational reputations, communication with other SBE-actors, collaborations, and the involvement of the government. Substantial barriers comprised a lack of SBE data, lack of innovative methods and materials for educational purposes, a shortage of human and physical resources, community resistance, untrained health care workers (HCWs), and ineffective traditional healing practices. In order to optimize and sustain SBE-CE practices, context-sensitive, multi-faceted approaches are needed that incorporate all these factors which influence its sustainable implementation.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"17 ","pages":"Article 100144"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/49/7c/main.PMC9764250.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10422038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plants causing poisoning outbreaks of livestock in South America: A review","authors":"Franklin Riet-Correa ,&nbsp;Mizael Machado ,&nbsp;Juan F. Micheloud","doi":"10.1016/j.toxcx.2023.100150","DOIUrl":"10.1016/j.toxcx.2023.100150","url":null,"abstract":"<div><p>This paper reviews toxic plants for livestock in South America. We included 219 plants in this review, considering only the plants that caused at least one demonstrated outbreak of poisoning. Plants reported as toxic in other regions and present in South America, but with no confirmed outbreaks of poisoning in this region, are not included. We report the main aspects of the epidemiology, clinical signs, pathology and economical importance of the poisonings. Initially, the toxic plants are described based on their toxic compounds, but because the toxic compound is unknown in 92 (42%) of the plants we also classify them according to the affected system. This review highlights the great diversity of toxic plants capable of affecting livestock in South America, and for this reason studies in this regard should be intensified.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"17 ","pages":"Article 100150"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/96/67/main.PMC9898795.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10665946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the properties of Bungarus caeruleus venom and checking the efficacy of antivenom used in Bangladesh for its bite treatment","authors":"Md Jahangir Alam ,&nbsp;Md. Mahmudul Hasan Maruf ,&nbsp;Md Asif Iqbal ,&nbsp;Mahedi Hasan ,&nbsp;Md Sohanur Rahman Sohan ,&nbsp;Md Ragib Shariar ,&nbsp;Ibrahim Khalil Al Haidar ,&nbsp;Mohammad Abdul Wahed Chowdhury ,&nbsp;Aniruddha Ghose ,&nbsp;Kazi Md Faisal Hoque ,&nbsp;Md Abu Reza","doi":"10.1016/j.toxcx.2023.100149","DOIUrl":"https://doi.org/10.1016/j.toxcx.2023.100149","url":null,"abstract":"<div><p>As a disaster-prone country with unique geographical features, snake biting is a major public health concern in Bangladesh. The primary reasons of mortality from snakebite include late presentation to the hospital, low efficacy of antivenom, and a lack of adequate management facilities. Because snake venom characteristics vary depending on geographical location, antivenom should be manufactured from snakes native to the region in which it would be administered. <em>Bungarus caeruleus</em> is a highly venomous snake contributing to the major snakebite issue in Bangladesh. Therefore, the neutralization efficacy of the antivenom against <em>B. caeruleus</em> venom was evaluated in the current study along with the characterization of venom. For biological characterization of venom, RP-HPLC and SDS-PAGE profiling, hemolytic activity, hemorrhagic activity, phospholipases A₂ (PLA₂) activity, edema inducing activity and histopathological observations were carried out following standard protocol. LD₅₀ of the venom was calculated along with neutralization potency of Incepta antivenom through probit analysis. Results showed that venom possesses phospholipase A₂ activity, hemolytic activity and edema inducing activity while hemorrhagic activity was absent in the skin of envenomed mice. Histopathological alterations including necrosis, congestion and infiltrations were observed in envenomed mice organs after hematoxylin and eosin staining. Neutralization study showed that Incepta polyvalent antivenom could neutralize (potency 0.53 mg/ml) the lethal effect in <em>in vitro</em> study on mice. Further investigation on snakebite epidemiology and clinical observations of the envenomed patients will help in combating the snakebite problem more efficiently.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"17 ","pages":"Article 100149"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50170901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aflatoxins contents determination in some foodstuffs in Burkina Faso and human health risk assessment","authors":"Moumouni Bandé ,&nbsp;Inna Traoré ,&nbsp;Fulbert Nikiema ,&nbsp;Naamwin-So-Bawfu Romaric Méda ,&nbsp;Dissinvel S. Kpoda ,&nbsp;Bazoin Sylvain Raoul Bazié ,&nbsp;Marceline Ouédraogo/Kagambèga ,&nbsp;Inoussa Ilboudo ,&nbsp;Ouambila Isidore Sama ,&nbsp;Abdoul Kiswensida Müller Compaoré ,&nbsp;Naa-Imwine Stanislas Dimitri Meda ,&nbsp;Bernadette Pane Ouattara Sourabie ,&nbsp;Hervé Hien ,&nbsp;Élie Kabré","doi":"10.1016/j.toxcx.2022.100138","DOIUrl":"10.1016/j.toxcx.2022.100138","url":null,"abstract":"<div><p>Aflatoxins are produced by fungi of the genus Aspergillus that colonize many foodstuffs during agricultural production, harvesting, transportation, storage, and food processing. In view of these aflatoxins toxicity to humans, their presence in foods such as cereals and oilseeds constitutes a major challenge for global food security, health and nutrition. This study was therefore initiated to assess the level of aflatoxin contamination of various foodstuffs sold in urban and semi-urban markets in Burkina Faso, and to evaluate the carcinogenic risk which the consuming population is exposed to. Two hundred and twelve foodstuff samples were collected in two large cities (Ouagadougou and Bobo Dioulasso) and three semi urban localities (Cinkansé, Dakola and Niangoloko). Aflatoxins contents in foodstuffs were determined by immunoaffinity chromatography and human health risk assessment was performed by using the Monte Carlo algorithm. The aflatoxins contents determination showed that 41.50% of studied samples were contaminated with concentrations up to 182.28 μg/kg for AFB1 in peanuts. Chronic Daily Intake, calculated based on the consumption patterns assumed in this study, was estimated to be higher in large cities (CDI = 33.68 μg/kg bw in Ouagadougou and 10.18 μg/kg bw in Bobo Dioulasso) than in semi urban localities (CDI = 4.29 μg/kg bw in Cinkansé, CDI = 0.39 μg/kg bw in Dakola and CDI = 0.18 μg/kg bw in Niangoloko). The MOE determination showed that the sorghum meal and whole grain maize consumption was associated to the carcinogenic risk for public health in large cities (the percentile 95 of MOE = 3316 for rice, 4511 for peanuts, 3334 for sorghum meal and 4530 for whole grain maize). In semi urban localities, no carcinogenic risk was observed to public health. These results should inspire the country's sanitary and agricultural authorities to undertake actions to fight against the agricultural food products contamination by aflatoxins in order to safeguard the population's health.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"16 ","pages":"Article 100138"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/62/a2/main.PMC9525995.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33501244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping of clinical management resources for snakebites and other animal envenomings in the Brazilian Amazon","authors":"Timothy P. Beck ,&nbsp;Anna Tupetz ,&nbsp;Altair Seabra Farias ,&nbsp;Alexandre Silva-Neto ,&nbsp;Thiago Rocha ,&nbsp;Emily R. Smith ,&nbsp;Felipe Murta ,&nbsp;Flavio Santos Dourado ,&nbsp;Deugles Cardoso ,&nbsp;Tatyana A. Ramos ,&nbsp;André Sachett ,&nbsp;Thiago Serrão Pinto ,&nbsp;Manuela Berto Pucca ,&nbsp;Vanderson Sampaio ,&nbsp;Flavia Ramos ,&nbsp;João Nickenig Vissoci ,&nbsp;Jacqueline Sachett ,&nbsp;Fan Hui Wen ,&nbsp;Catherine A. Staton ,&nbsp;Charles J. Gerardo ,&nbsp;Wuelton Monteiro","doi":"10.1016/j.toxcx.2022.100137","DOIUrl":"10.1016/j.toxcx.2022.100137","url":null,"abstract":"<div><p>Snakebite envenomings (SBEs) and other envenomings triggered by venomous animals (VAEs) represent a significant disease burden in Brazil, with 29,152 SBEs reported in 2021 alone with nearly half of those occurring in the remote Brazilian Amazon. In 2021, Brazil recorded 240,294 envenomings from snakes, scorpions, spiders, and caterpillars. Therefore, there is an unequal distribution of SBEs with high morbidity and mortality in the Brazilian Amazon. The severity of SBEs increases when patients require more than 6 h to access antivenom treatment, a common issue for the rural and indigenous populations. Understanding currently available resources and practices in Amazon remote areas of Brazil can serve to inform future interventions and guide health care policies. This study aims to develop a resource map of existing healthcare resources for the Brazilian Amazon's clinical management of VAEs with emphasis in SBEs, which will aid future strategic interventions. Data collection included a literature review, secondary data collected by government departments and organizational records, GIS mapping activities, and expert input. Our framework was guided by the three levels of healthcare service ecosystem analysis (macro, meso, and micro). Our resource map lays out a comprehensive overview of antivenom access, the distribution landscape, differences in patient transportation, and barriers to access healthcare that face populations in the Brazilian Amazon.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"16 ","pages":"Article 100137"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/85/dd/main.PMC9489497.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33485372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uniting behind a common goal: Collaboration between traditional healers and allopathic health care workers to improve rural snakebite care","authors":"Jonathan Steinhorst ,&nbsp;Frank-Leonel Tianyi ,&nbsp;Abdulrazaq Garba Habib ,&nbsp;George O. Oluoch ,&nbsp;David G. Lalloo ,&nbsp;Ymkje Stienstra","doi":"10.1016/j.toxcx.2022.100140","DOIUrl":"10.1016/j.toxcx.2022.100140","url":null,"abstract":"<div><p>Snakebite envenoming is an acute medical emergency which affects hundreds of thousands of people worldwide, primarily in remote rural areas of low-and middle income countries in the Global South. A considerable proportion of snakebite patients turn to traditional healers (THs) for help, driven by a number of push and pull factors. These include socio-cultural factors, geographical proximity, and the absence or inaccessibility of overstretched and often costly allopathic healthcare services. Although traditional healers and allopathic healthcare staff share a common focus -the recovery and well-being of their patients- both systems operate largely in parallel to each other with collaborations being an exception rather than the rule. This is to the detriment of snakebite patients, who frequently find themselves being caught-up in the dualism between the two separate systems. Given the right circumstances, snakebite patients could benefit from elements of care from both modalities. Here, we have reviewed the role of THs in snakebite care and explored how their integration into the formal healthcare system could improve the implementation and outcome of care. The effective recruitment of THs to aid in disease control and treatment efforts in diseases other than snakebite underscores the potential benefits of this strategy. Carefully devised proof of concept studies are needed to test our hypothesis that collaborations between the formal healthcare sector and THs are feasible and improve outcomes in snakebite care.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"16 ","pages":"Article 100140"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3d/e1/main.PMC9637966.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40476768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Snakebite knowledge assessment and training of healthcare professionals in Asia, Africa, and the Middle East: A review","authors":"Godpower Chinedu Michael ,&nbsp;Auwal Adam Bala ,&nbsp;Mustapha Mohammed","doi":"10.1016/j.toxcx.2022.100142","DOIUrl":"10.1016/j.toxcx.2022.100142","url":null,"abstract":"<div><p>Snakebite envenoming (SBE) is a common neglected tropical disease in rural communities of Asia, Africa and Latin America. Among the several challenges besetting the control of SBE is inadequate access to high-quality care by snakebite victims, partly contributed by inadequate knowledge of SBE among healthcare professionals (HCPs). This narrative review examined the existing literature on the knowledge of snakebites among HCPs, the factors associated with their knowledge of snakebites and their training needs. Data on the knowledge of healthcare professionals regarding snakebites appeared scanty and were predominantly from studies done in Asia, Africa, and the Middle East. We found that the proportion of health workers with adequate knowledge of local medically important snakes could be as low as 20.2% in some settings in India, while as much as three-quarters of health workers still recommend tourniquets and Blackstone as first aid in some settings in India and Rwanda, respectively. In addition, the mean knowledge score of local snake-induced clinical syndromes could be as low as 46.2% in some settings in Ghana, while 52.7% of tertiary hospital doctors in northern Nigeria recommend antivenom in all snakebite cases. Similarly, 23% of Bhutan health workers have adequate overall knowledge of snakebite management. Furthermore, several sociodemographic characteristics of the HCPs (such as increasing age, years of experience, work setting, medical specialty, health profession and previous involvement in snakebite management) are associated with adequate snakebite knowledge. Moreover, most studies have consistently reported a lack of training on snakebites as a challenge. Therefore, the knowledge gaps identified could be incorporated into training programs and regional policies on SBE treatment protocols.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"16 ","pages":"Article 100142"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/46/0a/main.PMC9692023.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40512835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}