Coagulopathy with defibrination is one of symptoms accompanying snakebite envenoming, where life-threatening complications such as massive bleeding and organ hematomas formation can occur. Here, we report a case of hemocoagulation failure due to bite by African Great Lakes bush viper Atheris nitschei with impossibility of specific treatment for absence of antivenom and its life-threatening complication: very rare and unexpected atraumatic splenic rupture with massive hemoperitoneum and necessity of urgent splenectomy.

• MeSH
• antiveniny terapeutické užití   MeSH
• hemoperitoneum etiologie   MeSH
• lidé MeSH
• ruptura sleziny * diagnóza   etiologie   chirurgie   MeSH
• uštknutí hadem * komplikace   MeSH
• Viperidae * MeSH
• zmijí jedy MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky 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

A snake breeder, 47-years-old man, was bitten by the saw-scaled viper (Echis carinatus sochureki). After admission to Toxinology Centre, within 1.5 h, laboratory evaluation showed clotting times prolonged to non-measurable values, afibrinogenaemia, significantly elevated D-dimers, haemolysis and myoglobin elevation. Currently unavailable antivenom was urgently imported and administered within 10 hours. In 24 hours, oligoanuric acute kidney injury (AKI) and mild acute respiratory distress syndrome (ARDS) developed. Despite administration of 10 vials of urgently imported Polyvalent Snake Antivenom Saudi Arabia, the venom-induced consumption coagulopathy (VICC) and AKI persisted. Another ten vials of antivenom were imported from abroad. VICC slowly subsided during the antivenom treatment and disappeared after administration of total 20 vials during 5 day period. No signs of haemorrhage were present during treatment. After resolving VICC, patient was transferred to Department of Nephrology for persisting AKI and requirement for haemodialysis. AKI completely resolved after 20 days. Despite rather timed administration of appropriate antivenom, VICC and AKI developed and the quantity of 20 vials was needed to cease acute symptoms of systemic envenoming. The course illustrates low immunogenicity of the venom haemocoagulation components and thus higher requirements of the antivenom in similar cases.

• MeSH
• akutní poškození ledvin * diagnóza   etiologie   terapie   MeSH
• antiveniny aplikace a dávkování   MeSH
• dialýza ledvin metody   MeSH
• hemokoagulace účinky léků   MeSH
• imunologické faktory aplikace a dávkování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• uštknutí hadem * krev   komplikace   patofyziologie   terapie   MeSH
• Viperidae * MeSH
• vyšetření krevní srážlivosti metody   MeSH
• výsledek terapie MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• zmijí jedy toxicita   MeSH
• zvířata MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Incidence uštknutí zmijí obecnou (Vipera berus) v ČR se pohybuje v řádu desítek případů ročně. Pouze v méně než polovině případů dojde k manifestní intoxikaci, z větší části mírné s lokálním nálezem a GIT nebo vegetativní symptomatologií. V těžších případech může dojít k rozvoji závažné intoxikace s vytvořením extenzivního otoku, oběhovými komplikacemi či ohrožením ledvinných funkcí, nutností symptomatické léčby a indikací k terapii antisérem. Článek stručně shrnuje toxinologické základy, klinické projevy a terapii intoxikace jedem zmije obecné včetně indikace terapie antisérem a jeho dostupnosti.

The incidence of common viper (Vipera berus) bites in the Czech Republic is within the range of tens of cases per year. Envenoming occurs in less than half of the cases, it is mostly mild with local finding and GIT or vegetativ symptomatology. In more severe cases can occurse envenoming with formation of extensive oedema, circulatory complications or compromised renal functions, which requires symptomatic treatment and treatment with an antiserum. The paper briefly summarised toxinologic bases, clinical signs and treatment of envenoming by the common viper venom including the indication and availability of the antivenom.

• Klíčová slova
• intoxikace,
• MeSH
• anafylaxe prevence a kontrola   terapie   MeSH
• antisérum aplikace a dávkování   škodlivé účinky   MeSH
• bolest MeSH
• edém diagnóza   terapie   MeSH
• hypotenze prevence a kontrola   terapie   MeSH
• lidé MeSH
• management bolesti MeSH
• příznaky a symptomy MeSH
• renální insuficience prevence a kontrola   terapie   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• šok prevence a kontrola   terapie   MeSH
• terapie MeSH
• toxikologická centra využití   MeSH
• uštknutí hadem komplikace   terapie   MeSH
• Viperidae MeSH
• Check Tag
• lidé MeSH

• MeSH
• dospělí MeSH
• lidé MeSH
• neurotoxické syndromy diagnóza   etiologie   metabolismus   MeSH
• nikotinové receptory metabolismus   MeSH
• nikotinoví agonisté * MeSH
• uštknutí hadem komplikace   diagnóza   metabolismus   MeSH
• Viperidae * MeSH
• výsledek terapie MeSH
• zmijí jedy * MeSH
• zvířata MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• dopisy MeSH
• kazuistiky MeSH

Incidence uštknutí zmijí obecnou se pohybuje v ČR v řádu desítek případů ročně, větší část postižení se týká dětí. Pouze asi v polovině případů dojde k intoxikaci, z větší části mírné s lokálním nálezem a GIT nebo vegetativní symptomatologií. V několika případech ročně však dochází k rozvoji těžší intoxikace s vytvořením extenzivního otoku, oběhovými komplikacemi či ohrožením ledvinných funkcí, s nutností symptomatické léčby a indikací k terapii antisérem. Článek stručně shrnuje toxinologické informace, klinické příznaky a terapii intoxikace jedem zmije obecné včetně indikace a dostupnosti antisér v ČR.

The incidence of common viper bites in the Czech Republic is within the range of tens of cases per year, with children being mostly affected. Envenomation occurs in only about half of the cases; it is mostly mild with a local finding and GIT or vegetative symptomatology. In a few cases yearly, however, more severe envenomation occurs with formation of extensive oedema, circulatory complications or compromised renal function, which requires symptomatic treatment and treatment with an antiserum. The paper briefly summarizes the toxinological information, clinical signs and treatment of envenomation by the common viper including the indications for and availability of antisera in the Czech Republic.

• Klíčová slova
• intoxikace,
• MeSH
• antisérum MeSH
• dítě MeSH
• lidé MeSH
• uštknutí hadem etiologie   farmakoterapie   terapie   MeSH
• Viperidae zranění   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH

BACKGROUND: Inflammatory bowel disease (IBD) care and education might differ around Europe. Therefore, we conducted this European Variation In IBD PracticE suRvey (VIPER) to investigate potential differences between countries. METHODS: This trainee-initiated survey, run through SurveyMonkey®, consisted of 47 questions inquiring basic demographics, IBD training, and clinical care. Results were compared according to gross domestic product (GDP) per capita, for which countries were divided into 2 groups (low/high income, according to the World Bank). RESULTS: The online survey was completed by 1,285 participants from 40 European countries, with a majority of specialists (65.3%) working in academic institutions (50.4%). Significant differences in IBD-specific training (55.9% vs. 38.4%), as well as availability of IBD units (58.4% vs. 39.7%) and multidisciplinary meetings (73.2% vs. 40.1%), were observed between respondees from high and low GDP countries (p < 0.0001). In high GDP countries, IBD nurses are more common (85.9% vs. 36.0%), also mirrored by more nurse-led IBD clinics (40.6% vs. 13.7%; p < 0.0001). IBD dieticians (33.4% vs. 16.5%) and psychologists (16.8% vs. 7.5%) are mainly present in high GDP countries (p < 0.0001). In the current COVID era, telemedicine is available in 73.2% versus 54.1% of the high/low GDP countries, respectively (p < 0.0001). Treat-to-target approaches are implemented everywhere (85.0%), though access to biologicals and small molecules differs significantly. CONCLUSION: Much variability in IBD practice exists across Europe, with marked differences between high and low GDP countries. Further work is required to help address some of these inequalities, aiming to improve and standardize IBD care and training across Europe.

• MeSH
• biologické přípravky * MeSH
• COVID-19 * MeSH
• idiopatické střevní záněty * epidemiologie   terapie   MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

A 34 year old male bitten by an adult Atheris squamiger snake developed symptoms of nausea, vomiting, diarrhea which were followed by drowsiness and impaired breathing. Local hemorrhage, edema and pain at the bite-site occurred, but no systemic bleeding or hemorrhagic diathesis developed. All clinical and laboratory parameters were in the normal range except for afibrinogenemia, thrombocytopenia and slight proteinuria. Replacement therapy (fibrinogen and platelet concentrates) and treatment of shock stabilized the patient within 2d and coagulation returned to normal. Atheris squamiger venom was subjected to biochemical and biological analysis. The LD50 of the venom was 5 mg/kg (mice, s.c.). It produced local hemorrhage corresponding to about 25% of the activity of puff adder venom (Bitis arietans). In vitro the venom had a fibrinogen-converting activity, it did not activate purified prothrombin but very likely contained a F V and Ca2+-dependent prothrombin activator. The venom exhibited strong platelet-aggregating activity, which was not inhibited by protease inhibitors and by EDTA or EGTA. The venom also aggregated acetylsalicylic acid treated platelets indicating, that the arachidonic acid pathway was not essential for activation. Rat serum rapidly inhibited the platelet-aggregating activity of the venom; human serum, however, had only a partial inhibitory effect. Preliminary experiments showed that platelet-aggregating activity may be separated from fibrinogen-converting activity by anion-exchange chromatography.

• MeSH
• afibrinogenemie * etiologie   terapie   MeSH
• agregace trombocytů účinky léků   MeSH
• chromatografie iontoměničová MeSH
• dospělí MeSH
• hemokoagulace účinky léků   MeSH
• injekce subkutánní MeSH
• krysa rodu rattus MeSH
• LD50 MeSH
• lidé MeSH
• myši MeSH
• nauzea etiologie   terapie   MeSH
• převod jednotlivých krevních složek MeSH
• průjem etiologie   terapie   MeSH
• trombocytopenie * etiologie   terapie   MeSH
• trombocyty účinky léků   MeSH
• uštknutí hadem * komplikace   MeSH
• Viperidae * MeSH
• zmijí jedy * farmakologie   chemie   MeSH
• zvířata MeSH
• zvracení etiologie   terapie   MeSH
• Check Tag
• dospělí MeSH
• krysa rodu rattus MeSH
• lidé MeSH
• mužské pohlaví MeSH
• myši MeSH
• zvířata MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

• MeSH
• epitel ultrastruktura   MeSH
• hadi anatomie a histologie   MeSH
• jazyk ultrastruktura   MeSH
• nervová vlákna ultrastruktura   MeSH
• nervová zakončení ultrastruktura   MeSH
• sarkolema ultrastruktura   MeSH
• sarkoplazmatické retikulum ultrastruktura   MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH

A reptile holder based in the Czech Republic was bitten into his hand and foot by the Northeast saw-scaled viper (Echis pyramidum). The person arrived at the health institution after twenty hours for anuria. Despite the antivenom against the Asian Echis carinatum – the Echis pyramidum's close relative – was readily available and administered repeatedly, the envenoming continued to develop with subsequent coagulopathy, hepatopathy and respiratory failure. The effects of plasmapheresis and symptomatic therapy were positive, but only temporary. Continual renal replacement therapy and plasmapheresis were complicated by thrombotic occlusions of the device tubing set. A turning point arrived following repeated application of imported antivenom containing antigens against venom components of another African saw-scaled viper species, Echis leucogaster (the antivenom containing E. pyramidum antigens was not available). The clinical status, including complications, resolved following 30 days of hospitalization. The case further validates the geographical specifics of immunogenicity of venom components with similar clinical action in snakes of the same genus.

• MeSH
• antiveniny terapeutické užití   MeSH
• dospělí MeSH
• lidé MeSH
• neúspěšná terapie MeSH
• uštknutí hadem terapie   MeSH
• Viperidae MeSH
• zvířata MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• kazuistiky MeSH