Phase II Clinical Trial to Establish Efficacy of a Locally Appropriate Bivalent Anti Snake Venom in Pakistan
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Keywords

Immunoglobulin [IgG], anti-snake venom [ASV], 20-minute WBCT, Echis carinatus sochureki [Lundi], Coagulopathy.

How to Cite

Quraishi, N., Ahmad, . T., Ghanghro, . A.-B., Arejo, . A., Muhammad, . S. S., & Chandio, . A. (2017). Phase II Clinical Trial to Establish Efficacy of a Locally Appropriate Bivalent Anti Snake Venom in Pakistan. Journal of Pharmacy and Nutrition Sciences, 7(3), 100–105. https://doi.org/10.6000/1927-5951.2017.07.03.5

Abstract

Objective: This study was conducted to determine the efficacy of Snake anti-venom Immunoglobulin [IgG] manufactured by Anti-Snake Venom [ASV]/Anti-Rabies [ARV] Serology Laboratory, Health Department, Government of Sindh.

Methods: The prospective, observational single arm study was conducted after the approval of IRB. Study included six patients with viper [Echis carinatus sochureki] snakebites referred to the emergency ward of Peoples University of Medical & Health Sciences Hospital, Nawabshah and District Headquarter Hospital Mithi, Sindh, Pakistan with consultation of Clinical and Principal investigator. The study was conducted over a period of three months [August 2015 to November 2015]. All patients were given IV infusion of 10 mL [1 vial] investigational ASV diluted in 100 mL normal saline except one patient who received 5 mL management dose and 5 mL subsequent dose for the recovery of coagulopathy. The efficacy was assessed by Primary and secondary efficacy endpoints, i.e. the dose at which maximum no of patients were treated [permanent restoration of normal blood coagulation tested by 20-minute whole blood clotting test [20-minute WBCT] with minimum toxicity.

Results: All patients recovered from coagulopathy after receiving IV infusion of 10 mL investigational ASV diluted in 100 mL normal saline tested by 20-minute WBCT. Mean Recovery time was 9:15 ± 3:25 hours.

Conclusion: Safety and efficacy was assessed for the Bivalent Anti venom Immunoglobulin-NQ1 [IgG] manufactured by ASV/ARV Serology Laboratory, Health Department, Government of Sindh.

https://doi.org/10.6000/1927-5951.2017.07.03.5
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References

Chippaux J-P. Estimating the global burden of snakebite can help to improve management. PLoS Med 2008; 5(11): e221. https://doi.org/10.1371/journal.pmed.0050221

Kasturiratne A, Wickremasinghe AR, de Silva N, et al. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med 2008; 5(11): e218. https://doi.org/10.1371/journal.pmed.0050218

Auerbach PS, Norris RL. Disorders caused by reptile bites and marine animal exposures. Harrisons Principles of Internal Medicine 2005; 16(2): 2593.

Suchithra N, Pappachan JM, Sujathan P. Snakebite envenoming in Kerala, South India: clinical profile and factors involved in adverse outcomes. Emergency Medicine Journal 2008; 25(4): 200-204. https://doi.org/10.1136/emj.2007.051136

Hansdak SG, Lallar KS, Pokharel P, Shyangwa P, Karki P, Koirala S. A clinico-epidemiological study of snake bite in Nepal. Tropical Doctor 1998; 28(4): 223-226. https://doi.org/10.1177/004947559802800412

Chandio AM, Sandelo P, Rahu AA, Ahmed ST, Dahri AH, Bhatti R. Snake bite: Treatment seeking behavior among Sindh rural population. JAMC 2000; 12(3).

Agarwal R, Aggarwal AN, Gupta D, Behera D, Jindal SK. Low dose of snake antivenom is as effective as high dose in patients with severe neurotoxic snake envenoming. Emergency Medicine Journal 2005; 22(6): 397-399. https://doi.org/10.1136/emj.2004.020727

Ilyas M. Community medcn, 4th ed. 1997.

http://asvsindh.gos.pk/project-digest/provincial-situation/

Warrell DA. Clinical toxicology of Snake bites in Asia. In: White MA, editor. Handbook of clinical toxicology of animal venoms and poisons. CRC Press 1995; pp. 493-588.

Warrell DA. Snake venoms in science and clinical medicine. 1. Russell's viper: biology, venom and treatment of bites. Trans R Soc Trop Med Hyg 1989; 83: 732-740. https://doi.org/10.1016/0035-9203(89)90311-8

Ansari AK, Sheikh SA. Management of Vipride Snake Bite. Pak Armed Forces Med J 2000; 50(1): 26-28.

Warrell DA. Poisoning by bites of the saw-scaled or carpet viper [Echis carinatus

Sitwat HA, et al. Study of snake bite cases at Liaquat university hospital Hyderabad/Jamshoro. J Ayub Med Coll Abbottabad 2008; 20(3): 125-127.

Hunter GW, Strickland GT, Eds. Hunter's tropical medicine and emerging infectious diseases. WB Saunders company, 2000; Vol. 857.

Gutiérrez JM, Lomonte B, Leon G, Rucavado A, Chaves F, Angulo Y. Trends in snakebite envenomation therapy: scientific, technological and public health considerations. Current Pharmaceutical Design 2007; 13(28): 2935-2950. https://doi.org/10.2174/138161207782023784

Warrell DA. The clinical management of snake bites in the Southeast Asian region. Southeast Asian J Trop Med Public Health 1999; 30(Suppl 1): 1-67.

Quraishi NA, Qureshi HI, Simpson ID. A contextual approach to managing snake bite in Pakistan: snake bite treatment with particular reference to neurotoxieity and the ideal hospital snake bite kit. JPMA. The Journal of the Pakistan Medical Association 2008; 58(6): 325-331.

Ahmed SM, Ahmed M, Nadeem A, Mahajan J, Choudhary A, Pal J. Emergency treatment of a snake bite: Pearls from literature. Journal of Emergencies, Trauma and Shock 2008; 1(2): 97. https://doi.org/10.4103/0974-2700.43190

Viravan C, Looareesuwan S, Kosakarn W, et al. A national hospital-based survey of snakes responsible for bites in Thailand. Transactions of the Royal Society of Tropical Medicine and Hygiene 1992; 86(1): 100-106. https://doi.org/10.1016/0035-9203(92)90463-M

Pandey DP. Epidemiology of snakebites based on field survey in Chitwan and Nawalparasi districts, Nepal. Journal of Medical Toxicology 2007; 3(4): 164-168. https://doi.org/10.1007/BF03160933

Hutton RA, Looareesuwan S, Ho M, Silamut K, et al. "Arboreal green pit vipers [genus Trimeresurus

Bhardwaj A, Sokhey J. Snake bites in the hills of north India. National Medical Journal of India 1998; 11(6).

Animal bites Fact sheet N°373. World Health Organization.

Zafar J, Aziz S, Hamid B, Qayyum A, Alam MT, Qazi RA. Snake bite: Experience at Pakistan Institute of Medical Sciences. Journal- Pakistan Medical Association 1998; 48: 308-310.

Lakhotia M, Pahadiya HR, Singh J, Gandhi R, Bhansali S. Lakhotia, Manoj, et al. Adrenal hematoma and right hemothorax after echis carinatus bite: An unusual manifestation. Toxicology International 2014; 21(3): 325. https://doi.org/10.4103/0971-6580.155388

http://asvsindh.gos.pk/project-digest/the-regional-situation

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Copyright (c) 2017 Naeem Quraishi , Tasneem Ahmad , Allah-Bux Ghanghro , Abdullah Arejo , Sharib S. Muhammad , Atta Chandio