Snakebites바카라that ancient scourge that has carried away so many over millennia and spawned gods and goddesses to whom terrified Indians prayed for assuagement바카라have lost none of their venom. With an estimated 46,000 deaths in India and at least thrice as many people injured every year, snakebite has been a complex but neglected problem. Now, new research is showing why envenomation by snakebite needs to be tackled swiftly, and on a bigger scale.
In December, a paper from the Indian Institute of Science (IISc) evaluated the efficacy of commercially available polyvalent anti-venoms against a few snake species other than the 바카라big four바카라바카라the spectacled cobra, the common krait, Russell바카라s viper, and the saw-scaled viper바카라and found that these lifesaving drugs could have serious deficiencies. By itself, the paper was only highlighting what experts had been pointing to for many years바카라the need to develop snake anti-venoms that can be more effective in dealing with the sheer biodiversity in India. Kartik Sunagar, assistant professor at IISc바카라s Centre for Ecological Sciences and author of the paper, points out that 바카라no one had conclusively shown till today that anti-Âvenoms don바카라t work바카라 against some negÂlected venomous snakes in India.
As Sunagar explains, Indian polyvalent anti-venoms are targeted at the big four which are believed to account for the bulk of snakebite casualties. But India can count up to 300 species of snakes, of which about 60 species could be medically important, meaning that their bite could cause a medical problem.
바카라In Rajasthan, there is the Sind Krait, which our study found is the most toxic snake in India,바카라 says Sunagar, who heads the Evolutionary Venomics Lab at IISc. 바카라I can say for sure that in the Northeast, the Big Four snakes do not cause such a problem but there are many other species that do. That바카라s why we need to figure out how we can address the regional differences in medically important snakes.바카라 There is a lot of geographic variation in venoms, which means even different populations of the same species can have very different venom compositions, expÂlains Sunagar. In many countries, the problem isn바카라t so complex as in India, with its diversity of snake populations.
One approach, researchers say, is to manufacture serum from venom sourced from several regional centres바카라currently, most anti-venom manufacturers, except for the government-run Haffkine Institute in Mumbai, procure venom from the Irula Snake Catchers Industrial Cooperative Society in Chennai. Anti-venom manufactured using venom samples from one region may not be suitable to treat bites by the same species of snake from another regÂion of the country, says Prof Ashis Mukherjee of Tezpur University. 바카라In Northeast India and in eastern India, the most prevalent species is Naja kaouthia (monocled cobra) and not Naja naja (spectacled cobra). In 2002, we demonstrated that anti-venom against Naja naja is partially effective in treating Naja kaouthia envenomation.바카라
Sunagar바카라s study, for instance, obsÂerved variations in the venom of two populations of the monocled cobra바카라while a sample from West Bengal was found to be highly neurotoxic (poisonous to the nervous system), samples obtained from Arunachal Pradesh were rich in cytotoxins (affecting cells and tissues).
The other approach is to develop next generation anti-venoms바카라currently, anti-venoms are made by collecting antibodies from horses which have been injected with diluted doses of snake venom. 바카라We have different ways of addressing this problem. All of those are leading to recombinant [an organism whose genetic complement results from recombination] anti-Âvenoms that bind to specific toxins and neutralise them,바카라 says Sunagar. 바카라Venom is a cocktail of different toxins. It is not just one component, but not all of those components are medically important. So, the idea is to produce antibodies only against those, using recombinant technology on culture plates, like we do for vaccines.바카라
Sunagar바카라s lab at IISc is part of a global research consortium, Scientific ReseÂarch Partnership for Neglected TropiÂcal Snakebite (SRPNTS), which is applying antibody discovery technologies to develop monoclonal antibodies바카라those made by identical immune cells바카라for snakebite treatment. 바카라Recombinant anti-venoms will take a long time, but you can바카라t just wait until these come,바카라 says Sunagar. 바카라That바카라s why we need to set up regional collection centres to collect venom from not only the big four but also these other medically important snakes.바카라
But better anti-venoms are only a part of the challenge. Since snakebites happen more in rural areas, expÂerts say the focus equally needs to be on creating awareness, providing training to doctors and necessary medical equipment like ventilators. Sadanand Raut of Vignahar Medical Foundation says his hospital near Pune has successfully treated over 4,800 patients of snakebite in the past 10-15 years with zero per cent mortality.
바카라Even complications like renal failure in Russell바카라s viper bite are reduced. All that is because of administering anti-venom in time along with other medical emergency management,바카라 Raut tells Outlook. He cites a 2017 study of 100 patients of Russell바카라s viper bite of whom 92 were brought to his hospital immediately and were treated with anti-venom and other emergency protocols. 바카라None of these 92 patients went into renal failure and they recovered fully. However, eight patients who came very late, about six-ten hours and didn바카라t get proper doses of anti-venom, all developed renal failure and required dialysis. So, this is proven...good emergency management and anti-venom in proper doses redÂuces mortality as well as morbidity.바카라 However, he says there needs to be a solution to treat the necrosis (cell injÂury) following snakebite.
Training doctors to handle snakebite victims, says Raut, is an essential step. 바카라Many doctors don바카라t know the basic things...how to do CPR and shock management. Also, doctors are hesitant in treating snakebite patients. But that can be changed by properly training them.바카라 Raut바카라s organisation is part of an Indian Council of Medical Research (ICMR) initiative to get actual statistics of snakebites in India, given that many cases don바카라t get reported.
Mukherjee, who is part of a snakebite task force committee recently constituted by ICMR and the ministry of family welfare to prepare a roadmap to tackle the problem, says the Department of Biotechnology and the Biotechnology Industry Research Assistance Council are supporting project proposals to devÂelop new generation anti-venoms and snakebite kits. 바카라I am sure that in the next couple of years the snakebite treatment scenario will be improved significantly,바카라 Mukherjee says. It바카라s time the virulent serpents met their match in a bold medical counter-stroke.
By Ajay Sukumaran in Bangalore
