INTRODUCTION: Snakebite incidence varies across Europe. However, there is limited research from Central and Southeastern Europe. These regions are notable for the presence of the common European adder (Vipera berus) and the more venomous nose-horned viper (Vipera ammodytes). No standard European antivenom protocol exists. The aim was to assess the epidemiology and treatment of viper bites in this region, focusing on a comparison of bites from Vipera berus and Vipera ammodytes. METHODS: We conducted a prospective multicenter study in Central and Southeastern Europe from 2018 to 2020. This study included poison centres and toxicology-associated hospital wards in Poland, the Czech Republic, Slovakia, Hungary, Slovenia, Croatia, Serbia, and Bulgaria. The following data were collected: age, gender, Vipera species, snakebite site, clinical picture, laboratory results, Audebert's clinical severity grading score, and antivenom therapy. RESULTS: The annual incidence of viper bites in Central and Southeast Europe was estimated at 2.55 bites per million population. Within their respective geographical distribution areas, the incidence of Vipera ammodytes bites (1.61 bites per million population) was higher than Vipera berus bites (1.00 bites per million population). Patients bitten by Vipera ammodytes more frequently reported local pain and developed thrombocytopenia. Antivenom treatment was more commonly administered in Vipera ammodytes bites (72%) compared to Vipera berus bites (39%). The incidence of Vipera ammodytes bites treated with antivenom within its geographical distribution area was three times higher than Vipera berus bites treated with antivenom (1.16 bites per million population versus 0.39 bites per million population). No deaths were reported. CONCLUSIONS: The estimated incidence of viper bites in Central and Southeastern Europe is at least 2.55 per million population. Vipera ammodytes bites are more common and severe, characterized by higher frequencies of pain and thrombocytopenia. Antivenom is needed more often for Vipera ammodytes bites. It is vital that enough European Medicines Agency-approved Vipera ammodytes antivenom is produced and offered affordably.

• MeSH
• antiveniny terapeutické užití   MeSH
• bolest MeSH
• lidé MeSH
• prospektivní studie MeSH
• trombocytopenie * MeSH
• uštknutí hadem * epidemiologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa MeSH

• MeSH
• cizí tělesa diagnostické zobrazování   MeSH
• dermatitida etiologie   farmakoterapie   patologie   terapie   MeSH
• dítě MeSH
• edém etiologie   terapie   MeSH
• hematom etiologie   terapie   MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• otrava rostlinami etiologie   farmakoterapie   patologie   terapie   MeSH
• otrava * etiologie   patologie   terapie   MeSH
• rány a poranění * diagnostické zobrazování   etiologie   patologie   terapie   MeSH
• uštknutí hadem epidemiologie   patologie   terapie   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: Snakebite envenoming is a neglected tropical disease that kills an estimated 81,000 to 138,000 people and disables another 400,000 globally every year. The World Health Organization aims to halve this burden by 2030. To achieve this ambitious goal, we need to close the data gap in snake ecology and snakebite epidemiology and give healthcare providers up-to-date knowledge and access to better diagnostic tools. An essential first step is to improve the capacity to identify biting snakes taxonomically. The existence of AI-based identification tools for other animals offers an innovative opportunity to apply machine learning to snake identification and snakebite envenoming, a life-threatening situation. METHODOLOGY: We developed an AI model based on Vision Transformer, a recent neural network architecture, and a comprehensive snake photo dataset of 386,006 training photos covering 198 venomous and 574 non-venomous snake species from 188 countries. We gathered photos from online biodiversity platforms (iNaturalist and HerpMapper) and a photo-sharing site (Flickr). PRINCIPAL FINDINGS: The model macro-averaged F1 score, which reflects the species-wise performance as averaging performance for each species, is 92.2%. The accuracy on a species and genus level is 96.0% and 99.0%, respectively. The average accuracy per country is 94.2%. The model accurately classifies selected venomous and non-venomous lookalike species from Southeast Asia and sub-Saharan Africa. CONCLUSIONS: To our knowledge, this model's taxonomic and geographic coverage and performance are unprecedented. This model could provide high-speed and low-cost snake identification to support snakebite victims and healthcare providers in low-resource settings, as well as zoologists, conservationists, and nature lovers from across the world.

• MeSH
• antiveniny terapeutické užití   MeSH
• celosvětové zdraví MeSH
• hadi MeSH
• lidé MeSH
• opomíjené nemoci diagnóza   epidemiologie   MeSH
• umělá inteligence MeSH
• uštknutí hadem * diagnóza   epidemiologie   terapie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• subsaharská Afrika MeSH

Delays in treatment seeking and antivenom administration remain problematic for snake envenoming. We aimed to describe the treatment seeking pattern and delays in admission to hospital and administration of antivenom in a cohort of authenticated snakebite patients. Adults (> 16 years), who presented with a confirmed snakebite from August 2013 to October 2014 were recruited from Anuradhapura Hospital. Demographic data, information on the circumstances of the bite, first aid, health-seeking behaviour, hospital admission, clinical features, outcomes and antivenom treatment were documented prospectively. There were 742 snakebite patients [median age: 40 years (IQR:27-51; males: 476 (64%)]. One hundred and five (14%) patients intentionally delayed treatment by a median of 45min (IQR:20-120min). Antivenom was administered a median of 230min (IQR:180-360min) post-bite, which didn't differ between directly admitted and transferred patients; 21 (8%) receiving antivenom within 2h and 141 (55%) within 4h of the bite. However, transferred patients received antivenom sooner after admission to Anuradhapura hospital than those directly admitted (60min [IQR:30-120min] versus 120min [IQR:52-265min; p<0.0001]). A significantly greater proportion of transferred patients had features of systemic envenoming on admission compared to those directly admitted (166/212 [78%] versus 5/43 [12%]; p<0.0001), and had positive clotting tests on admission (123/212 [58%] versus 10/43 [23%]; p<0.0001). Sri Lankan snakebite patients present early to hospital, but there remains a delay until antivenom administration. This delay reflects a delay in the appearance of observable or measurable features of envenoming and a lack of reliable early diagnostic tests. Improved early antivenom treatment will require reliable, rapid diagnostics for systemic envenoming.

• MeSH
• antiveniny terapeutické užití   MeSH
• čas zasáhnout při rozvinutí nemoci statistika a číselné údaje   MeSH
• dospělí MeSH
• hadí jedy * MeSH
• hadi MeSH
• hospitalizace statistika a číselné údaje   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• první pomoc MeSH
• uštknutí hadem diagnóza   epidemiologie   terapie   MeSH
• venkovské obyvatelstvo MeSH
• zvířata MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Srí Lanka MeSH

Autori prezentujú komplexný pohľad na súčasné poznatky po uhryznutí vretenicou (Vipera berus) v spojení so vstreknutím jedu (envenomáciou). Najčastejšie sa jedná o sezónny výskyt v rozmedzí jarných, letných až jesenných mesiacov (marec – október) a najčastejšie je to vretenica severná (obyčajná). Kazuistikami poukazujú na starostlivosť a manažment pacientov po intoxikácii hadím jedom.

The authors present a comprehensive view of the current knowledge of Vipera berus in conjunction with the injection of poison (envenomation). Most often it is a seasonal occurrence in the range of spring, summer to autumn months (March – October) and most often it is the Vipera berus. Case reports point to the care and management of patients after snake venom poisoning.

• MeSH
• antisérum MeSH
• dítě MeSH
• edém etiologie   MeSH
• hadí jedy MeSH
• lidé MeSH
• mladiství MeSH
• pasivní imunizace MeSH
• předškolní dítě MeSH
• uštknutí hadem * diagnóza   epidemiologie   patofyziologie   terapie   MeSH
• Viperidae zranění   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• přehledy MeSH

Autoři uváději devět stručných kazuistik méně obvyklých úrazů včetně obrazové dokumentace – uštknutí zmijí, poranění genitálu včetně „zip-injury“, „bowing fracture“, omrzliny a povrchní poranění v rámci CAN, fototoxickou fytodermatitidu po kontaktu s třemdavou bílou, perforující bodné poranění břicha a traumatickou luxaci kyčle s frakturou hlavice femuru. Článek je doplněn heslovitým přehledem dalších šestnácti úrazů z vlastní praxe, mnohdy kuriozního rázu.

The authors present nine short case reports of less common injuries including graphic documentation: viper bite; genital injuries including zip-injury; bowing fracture; frostbites and superficial injuries associated with CAN; phytophotodermatitis following contact with the gas plant; perforating stab wound to the abdomen; and traumatic dislocation of the hip with femoral head fracture. The article is supplemented with a brief outline of another sixteen injuries from the authors’ practice, often of curious nature.

• MeSH
• alergická kontaktní dermatitida epidemiologie   etiologie   MeSH
• dítě MeSH
• domácí násilí MeSH
• horní končetina zranění   MeSH
• lidé MeSH
• mladiství MeSH
• penis zranění   MeSH
• poranění dolní končetiny etiologie   MeSH
• poškození chladem epidemiologie   MeSH
• uštknutí hadem epidemiologie   farmakoterapie   MeSH
• zneužívané dítě diagnóza   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• antiveniny terapeutické užití   MeSH
• hadi klasifikace   MeSH
• lidé MeSH
• uštknutí hadem farmakoterapie   epidemiologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• dopisy MeSH
• komentáře MeSH

UNLABELLED: Only one natural venomous snake-the adder viper-lives in the central European region and its bite is usually associated only with mild course of envenoming. Cases of envenoming caused by exotic snakes among their breeders are clinically more important. OBJECTIVE: The aim of this study was to analyze the epidemiological and clinical aspects of registered venomous bites caused by exotic snakes in the Czech Republic over a period of 15 years (1999-2013). MATERIALS AND METHODS: This is an observational case series. Data have been collected retrospectively from a database and medical charts of the Toxinology Center belonging to the General University Hospital in Prague. RESULTS: In total, 87 cases of exotic snakebites caused by 34 venomous snake species were registered during the study period, coming from 18 genera of Elapinae, Viperinae, and Crotalinae subfamilies. In the cohort, 29 patients (33.3%) developed systemic envenoming and 17 (19.5%) were treated with antivenom. Ten cases of envenoming (11.5%) were considered as potentially life threatening. No patient died due to envenoming caused by exotic snake bites during the study period. Four illustrative cases of envenoming (Echis pyramidum, Dendroaspis polylepis, Protobothrops mangshanensis, and Proatheris superciliaris) are described in detail. CONCLUSION: Bites caused by exotic snakes resulted in serious and life-threatening envenomings in some patients. Early transfer to the Center, antivenom administration, and support of failing organ functions contributed to favorable outcome of victims.

• MeSH
• antiveniny terapeutické užití   MeSH
• chov zvířat pracovní síly   MeSH
• Crotalus MeSH
• dospělí MeSH
• Elapidae MeSH
• incidence MeSH
• kohortové studie MeSH
• konziliární vyšetření a konzultace MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• multiorgánové selhání etiologie   prevence a kontrola   MeSH
• nemoci z povolání epidemiologie   patofyziologie   terapie   MeSH
• nemocnice univerzitní MeSH
• retrospektivní studie MeSH
• stupeň závažnosti nemoci MeSH
• urgentní zdravotnické služby MeSH
• uštknutí hadem epidemiologie   patofyziologie   terapie   MeSH
• Viperidae MeSH
• zvířata MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Česká republika MeSH

The aim of this study was to analyse most important epidemiological and clinical aspects of registered snakebites caused by a native common European viper Vipera berus in the Czech Republic over a period of 15 years (1999–2013). Data have been collected retrospectively from a database of the Toxinology Centre belonging to the General University Hospital in Prague. In total, 191 cases of snakebites caused by common viper were registered during the study period. Systemic envenoming occurred in 49 (25.7%) patients, local envenoming without systemic symptoms was recorded in 91 (47.6%) and asymptomatic dry bites were seen in 51 (26.7%) cases, respectively. Twenty-four patients (12.6% of all bites) were treated with administration of antivenom. None of the victims died as a result of snakebite during the observation period. Native viper snakes usually did not cause serious harm to the patients, with the exception of children. Antivenom should be administered in all cases with systemic manifestations, in children even with serious local affection and administered as soon as possible. Envenomed patients should be admitted to the hospital and treated at least under supervision of specialists with experience in snakebite treatment, who can indicate and provide administration of the antivenom.

• MeSH
• antiveniny terapeutické užití   MeSH
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• retrospektivní studie MeSH
• roční období * MeSH
• uštknutí hadem farmakoterapie   epidemiologie   MeSH
• Viperidae * MeSH
• zmijí jedy * MeSH
• zvířata MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• antiveniny farmakologie   terapeutické užití   MeSH
• hadí jedy farmakologie   toxicita   MeSH
• komplikace těhotenství MeSH
• lidé MeSH
• maternofetální výměna látek fyziologie   účinky léků   MeSH
• placentární oběh účinky léků   MeSH
• těhotenství MeSH
• uštknutí hadem * epidemiologie   terapie   MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH