11/23/2013 1 VENOMOUS SNAKES OF VENOMOUS SNAKES OF MEDICAL IMPORTANCE & MEDICAL IMPORTANCE & SNAKE BITES SNAKE BITES MANAGEMENT IN VIETNAM MANAGEMENT IN VIETNAM Trinh Trinh Xuan Xuan Kiem Kiem, Trinh Kim , Trinh Kim Anh Anh, Le , Le Khac Khac Quyen Quyen, Nguyen Ba , Nguyen Ba Phuoc Phuoc, , Thai Thai Danh Danh Tuyen Tuyen, Trinh , Trinh Xuan Xuan Long, Pham Long, Pham Manh Manh Hung, David Hung, David A. A. Warrell Warrell, at al. , at al. INTRODUCTION INTRODUCTION For centuries, there have been of snake bites patients with an associated with high morbidity and mortality, particularly in tropical countries such as Vietnam. However, this medical problem has been neglected. . 100 years ago, in Saigon Pasteur Insti, Dr. Calmette was the first Dr in the World to research Cobra AV & applied for 02 patients successfully. WHO, 1971: “AV has been the most effective form & widely used for snake bite treatments in the World.” But no AV developed in VN until 1990. BEFORE 1990 BEFORE 1990 There are # 30,000 cases of bites/year. Most snake bite victims were treated by non specific methods, which were t td il t th t diti lh l entrusted mainly to the traditional healers - Mortality: 19.8 % (Severe envenoming) - Amputation: 11% - Deformity: 14 %
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11/23/2013
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VENOMOUS SNAKES OF VENOMOUS SNAKES OF MEDICAL IMPORTANCE &MEDICAL IMPORTANCE &
SNAKE BITES SNAKE BITES MANAGEMENT IN VIETNAMMANAGEMENT IN VIETNAM
Trinh Trinh XuanXuan KiemKiem, Trinh Kim , Trinh Kim AnhAnh, Le , Le KhacKhac QuyenQuyen, Nguyen Ba , Nguyen Ba PhuocPhuoc, , Thai Thai DanhDanh TuyenTuyen, Trinh , Trinh XuanXuan Long, Pham Long, Pham ManhManh Hung, David Hung, David A. A. WarrellWarrell, at al., at al.
INTRODUCTIONINTRODUCTION
For centuries, there have been of snake bites patients with an associated with
high morbidity and mortality, particularly in tropical countries such as Vietnam.
However, this medical problem has been neglected.
.
100 years ago, in Saigon Pasteur Insti, Dr. Calmette was the first Dr in the World to research Cobra AV & applied for 02 patients successfully.
WHO, 1971: “AV has been the most effective form & widely used for snake bite treatments in the World.”
But no AV developed in VN until 1990.
BEFORE 1990BEFORE 1990
There are # 30,000 cases of bites/year. Most snake bite victims were treated by non specific methods, which were
t t d i l t th t diti l h lentrusted mainly to the traditional healers
- Mortality: 19.8 % (Severe envenoming)
- Amputation: 11%
- Deformity: 14 %
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METHODSMETHODS
1.-Epidemiology of snakebites & identification of snakes by Alberdin & Oxford Universities.
5.1.- More than 3,000 snake bite patients were treated AVs to give a good response: Safety & Efficacy.
5.2.- Comparative study with group counterpart, but not AVs available for treatment before:
* Reduced the mortality from 19.8 % to 1.5 %.
* Reduced amputation from 11% to 1%.
* Reduced permanent deformity from 14% to 5%.
* Reduced the mean time for recovering completely from 45 days to 72 hrs.
AV reactions:AV reactions:
1) -Early reactions:
- Anaphylactic shock (2.3%).
- Pyrogenic reaction (15.2%)
2) -Late reaction (serum sickness type) < 1 %.
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42
58 59
42
58
30
40
50
60
Comparison of clinical efficacy between two groups (a) and (b) at Cho Ray Hospital
1114
8
13 1410
14
1,8%
22%
0
10
20
30
Admission N. Eye
muscle
Ar. V
ceased.
Mus
power
Osermann Glasgow Mortality
Group (a): NKAV (54P)
Group (b): Non NKAV (9P)
P<(0,001)
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314
417
529
400
500
600
700
800
900
v ic t ims
number o f sna c k bi t e v ic t ims a t Ch o Ra y
Ho spi t a l in so ut h er n Vie t Na m f r o m 1976 t o 1996
0 0 4 11 6 9 11 39
67
71
128
151
71
68
103
216299
358
0
100
200
300
400
1976 85 87 89 91 93 95
Envenoming victims Non – envenoming victims
80 86 88 90 92 94 96
STRATEGY OF SCIENTIFIC RESEARCHSTRATEGY OF SCIENTIFIC RESEARCH
The scientific research collaboration between The scientific research collaboration between VN VN –– USC (U.S) to make a new candidate drug USC (U.S) to make a new candidate drug from snake venom for cancer treatment in VN.from snake venom for cancer treatment in VN.
Since 2001, the project has been started. Since 2001, the project has been started. p jp jIt was approved by VN Government in 2013.It was approved by VN Government in 2013.The first result: These The first result: These DisintegrinsDisintegrins from from CR CR were found with a good biological function to were found with a good biological function to
anti cancer cells & tumors. anti cancer cells & tumors. Recombinant Recombinant DisintegrinsDisintegrins & Nano technology & Nano technology will be applied for making an Antiwill be applied for making an Anti--cancer drug. cancer drug.
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A group of top government science andtechnology officials from Vietnam visited USCon Sept.17,2013 and meeting with researchers.Frank Markland Ph.D., professor ofbiochemistry and molecular biology hosted thevisit, which also featured discussion of hiscollaboration with researchers at the Researchcollaboration with researchers at the ResearchInstitute for Rural Technology and Hai PhongMedical University both in Vietnam. Theirresearch seeks ways to use snake venompeptides as chemical weapons against breastand prostate cancers.
CONCLUSIONCONCLUSION1) The venomous snakes of medical importance &
epidemiology of snakebites in VN were identified: 2 families & 10 species # 30,000 cases of bites/ year.
2) Two envenomed syndromes characterized for each: Neurotoxicity & Coagulation Disorders (DIC-Fibrinolysis)
3) 5 main kinds of AVs have been researched & produced to have a good safety efficacy & permitted forproduced to have a good safety, efficacy & permitted for use since 1998. 4) The scientific research collaboration between VN-USC to find a new candidate drug for cancer treatment has been establishing & performing well.
(1): PCC of Bach Mai hospital, Hanoi., Vietnam. (2): Cho Ray hospital, Ho Chi Minh City, Vietnam. (3): The University of Oxford, Nuffield Department of Clinical Medicine.