The SR found 19 studies consisting of 24 people with severe North American Pit Viper envenomation[ 19]. Seven cases were described in five cohort studies and 17 cases were described in 14 single patient case reports or non-cohort case series. Persistent severe venom effect (limb swelling, limb pain, soft tissue bleeding, thrombocytopenia, neurotoxicity, or compartment syndrome) was seen in 0% of patients in cohort study but 53% of patients in non-cohort reports. No patient developed systemic bleeding but recurrent and/or delayed-onset severe defibrination syndrome was found in patients. The genus Naja is composed of a large number of snakes, totaling 33 species [ 14], including N. naja, N. annulifera, N. melanoleuca, N. mossambica, and N. nigricollis. Most species have neurotoxic venom, acting on the nervous system, causing paralysis. In addition, many venoms from Naja spp. have cytotoxic characteristics that cause swelling and necrosis, in addition to cardiotoxic components [ 15]. WHO . 2019. Snakebite Envenoming: a Strategy for Prevention and Control. https://www.who.int/publications/i/item/9789241515641 Geneva, Available from: [ Google Scholar] WHO . 2021. Snakebite envenoming. https://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming Fact sheets. [ Google Scholar]

The SR included 19 cohort studies (two cohorts were within the context of RCTs) consisting of 1017 patients. Late bleeding was seen in nine patients (0.9%; 95% CI 0.4% to 2.2%) with five patients developing medically significant late bleeding. (0.5%; 95% CI 0.1% to 1.7%) [ 14]. Eight of the nine patients who had late bleeding were cases of Rattlesnake envenomation. No deaths or sequalae of any kind was reported. Prophylactic fasciotomy (done before compartment syndrome develops in Crotaline spp) alone or in combination with standard therapy including SAV was found to not improve outcomes. The outcomes were not explicitly specified but are related to "scarring and wound-healing" and "elevated compartment pressure". The quality of evidence was determined to be moderate by the consensus group and was based on two human and one porcine study.Specific neutralizing antibodies were first identified in the serum of experimental animals, i.e., rabbits or guinea pigs, immunized against diphtheria or tetanus toxins [ 34]. In 1894, the serum was successfully used for treating children suffering from severe diphtheria, and was manufactured by Burroughs Welcome, United Kingdom. In the same year, two groups, simultaneously but independently, described the antitoxic properties of the serum from rabbits and guinea pigs immunized against cobra and viper venoms [ 34, 35]. In 1895, a similar procedure was repeated with horses immunized with snake venoms in India by Haffkine and in Vietnam by Lépnay [ 36]. The snake antivenom specificity—whose range includes the biting species—was demonstrated by Vital Brazil [ 37, 38]. Syn-peptides are synthetically manufactured peptides that are similar in structure to a naturally occurring peptide. They are designed to mimic the action of the naturally occurring form. Peptides are essentially short proteins and are used in skincare formulations as they are often small enough to penetrate through the skin. Syn-peptides have been created to combat the appearance of wrinkles, pigmentation and increase the natural protective abilities of the skin. Is Syn-ake Actually Safe? Significant decrease in the duration of hospitalisation in those whose snakebite wound was incised in comparison to those whose bite wound was not incised (2.9±1.6 days vs 4.6±2.2 days; MD -1.70 days; p = 0.03)

Johnson PN, McGoodwin L, Banner W Jr.. Utilisation of Crotalidae polyvalent immune fab (ovine) for Viperidae envenomations in children. Emerg Med J. 2008;25(12):793–8. Epub 2008/11/27. pmid:19033492. No significant increase in the duration of hospitalisation (median 6 days vs. 4 days, p = 0.7) compared to those who did not receive suction. There was only one SR under this category which was done in the context of consensus-based recommendations being developed for surgical consideration for North American Pit Viper ( Crotalinae) envenomation [ 18]. It found evidence on several key issues, one of which pertained to diagnostic accuracy issues and hence not of interest (diagnostic criteria for compartment syndrome) to this overview: Population: SRs that have included studies with patients being treated for snakebite envenoming (irrespective of the snake species and irrespective of the age and sex of the participants or the setting).Zheng Z, Chen G, Liang W, Ji X, Yin J, Liu M, et al. [Clinical application of VSD negative pressure aspiration and detoxification in severe snake bite]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017;29(11):1026–9. Epub 2017/11/21. pmid:29151420. The Bitis genus includes six species responsible for a large number of bites: B. arietans, B. somalica, B. parviocula, B. gabonica, B. rhinoceros, and B. nasicornis [ 9, 10]. Harrison R.A., Hargreaves A., Wagstaff S.C., Faragher B., Lalloo D.G. 2009. Snake Envenoming: A Disease of Poverty. 3(12) [ PMC free article] [ PubMed] [ Google Scholar] Venom has been used throughout history to treat illness and there has been a significant amount of research in recent times into the potential applications of synthetic venoms to treat a variety of ailments. For example, ziconotide from cone snails to treat chronic pain or lepirudin from leeches to prevent blood clots. Minghui R., Malecela M.N., Cooke E., Abela-ridder B. Comment WHO ’ s snakebite envenoming strategy for prevention and control. Lancet Glob. Heal. [Internet] 2019; 7(7) doi: 10.1016/S2214-109X(19)30225-6. Available from: [ PubMed] [ CrossRef] [ Google Scholar]