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The concept of One Health, a system-based approach that acknowledges the interdependence of human, animal, and ecosystem health, has grown in prominence over the past few decades. This transdisciplinary concept is increasingly important as the climate crisis, directly and indirectly, impacts all aspects of the planetary web of life. In tandem with the rise of One Health has been the increasing adoption of digital technologies into healthcare practice and within methods used to research human and environmental health. Emerging at the intersection of One Health and Digital Health is the idea of One Digital Health. This syncretic concept explores the opportunities that digital health presents to further the utility and operationalisation of One Health. A notable feature of the One Digital Health model is the role of citizen engagement. This feature aligns the digital approach with many One Health interventions that use citizen science to improve human, animal, and environmental health. This paper reports the results of a rapid review followed by a deep-dive into several representative studies exploring the intersections of One Health, digital health, and citizen science to identify new domains of innovative practice that supports resilience in the face of climate change and environmental health hazards. A focus on air quality reflects its importance in the One Health literature.

Sharing Place, Learning Together (SPLT) is a cross-disciplinary education project that aims to develop the English and Science literacy skills of remote Aboriginal students. The project comprises an interdisciplinary team from the University of Melbourne (UoM) partnering with Maningrida College and the Djelk Rangers (Bawaninga Aboriginal Corporation) to support the College’s ‘Learning on Country’ program. Through cross-cultural exchanges and ‘on country’ visits Aboriginal biocultural knowledge is integrated with Western scientific understanding to develop curriculum and literacy resources. This paper details SPLT’s evolvement and discusses activities and learning experiences the partnership has generated. Linked to the project’s development, the paper presents the findings of a research study that investigated mutual capacity and partnership building between the Maningrida College Community and UoM. These findings reveal that relationship-building, coupled with a sustained presence ...

Diagnosis and management of venomous bites and stings, particularly snakebite, is important for Australian clinicians. In 2015, a flipped classroom was trialled to teach the principles of envenomation to year 1 medical students in a MD program. A bespoke online resource was developed and then used by students to prepare for a face-to-face class tailored to their learning needs. Students reported positively about learning the principles of envenomation with the online resource and found it useful. Responses from students also indicated that the interactive class was beneficial to their learning, particularly the clinical application of envenomation. These findings were supported by comparisons of pre- and post-test scores that showed significant learning gains across eight questions. The study also provided some insights into students’ perception of knowledge retention and why some students may prefer to prepare individually for content attainment.

Abstract Alpaca (Vicugna pacos) are domesticated members of the camelid family that have been shown to produce an IgG subclass that is heavy chain only IgG. This camelid-type IgG has been postulated to have improved neutralising properties and reduced immunogenicity, compared with conventional mammalian IgG. This study was undertaken to describe the physiological and antibody responses of alpaca (Vicugna pacos) used for the production of an experimental camelid antivenom. Various antivenom products were developed by immunisation of alpaca with combinations of five Australian elapid snake venoms: common tiger snake (Notechis scutatus), eastern brown snake (Pseudonaja textilis), Papuan taipan (Oxyuranus scutellatus canni), mulga snake (Pseudechis australis) and common death adder (Acanthophis antarcticus) were emulsified with Freund’s Adjuvant and injected monthly using a low dose multi-site approach. Venom specific immune responses were monitored by ELISA. Physiological effects upon alpaca were monitored by clinical examination combined with serial haematology and biochemical profiles. Serum was harvested once immune responses had peaked and the IgG fraction concentrated by ammonium sulphate precipitate of non-IgG proteins. Total serum IgG and total serum protein concentrations increased and decreased in synchrony with boosting specific antibodies. The difference in serum creatinine kinase concentration measured at 24 h after each of the first three immunisations decreased as the alpaca mounted an antibody response to the venom antigens measured by ELISA. In conclusion, alpaca responded to repeated immunisation with various Australian elapid venoms by mounting an increasing antibody response that persisted following prolonged rest with minimal physiological impact on the animal.

We want to discuss antivenom use in snakebite clinical practice guidelines. Coronial reviews in Victoria of two cases of snakebite envenomation, one described in detail below, prompted us to submit this paper for a wider audience and debate. Venom and antivenom levels were measured in the case detailed below, but not in the other. The coroner received conflicting and varied advice from experts regarding the dose of antivenom. The Victorian Department of Health and Human Services and the Australasian College for Emergency Medicine were instructed to review snakebite management guidelines, particularly with respect to antivenom dosage. The discussion that took place among medical experts led to considerable media attention. We discuss the potential fallout when there is no consensus among medical experts.

Pseudonaja textilis is a widespread and common snake in eastern parts of Australia, but its distribution in New Guinea is poorly understood, and the origin of the New Guinea populations and its timing have been the subject of much speculation. Phylogenetic analysis of mitochondrial DNA sequences from three New Guinea populations of P. textilis indicates that New Guinea was colonised from two independent eastern and western migration routes most likely in the Pleistocene. One dispersal event from northern Queensland led to the populations in eastern New Guinea (Milne Bay, Oro and Central Provinces, Papua New Guinea), whereas another, from Arnhem Land to central southern New Guinea, led to the populations from the Merauke area, Indonesian Papua. The results are consistent with the effects of Pleistocene sea level changes on the physical geography of Australasia, and are thus suggestive of a natural rather than anthropogenic origin of the New Guinea populations. The taxonomic status of...

The Snake Venom Detection Kit (SVDK; bioCSL Pty Ltd, Australia) distinguishes venom from the five most medically significant snake immunotypes found in Australia. This study assesses the rate of false positives that, by definition, refers to a positive assay finding in a sample from someone who has not been bitten by a venomous snake. Control unbroken skin swabs, simulated bite swabs and urine specimens were collected from 61 healthy adult volunteers [33 males and 28 females] for assessment. In all controls, simulated bite site and urine samples [a total of 183 tests], the positive control well reacted strongly within one minute and no test wells reacted during the ten minute incubation period. However, in two urine tests, the negative control well gave a positive reaction (indicating an uninterpretable test). A 95% confidence interval for the false positive rate, on a per-patient rate, derived from the findings of this study, would extend from 0% to 6% and, on a per-test basis, it would be 0-2%. It appears to be a very low incidence (0-6%) of intrinsic true false positives for the SVDK. The clinical impresssion of a high SVDK false positive rate may be mostly related to operator error.

Abstract Alpaca (Vicugna pacos), like all other members of the camelid family, produce a unique heavy chain only IgG subclass. This form of IgG has been proposed as having superior neutralising properties and improved safety as compared with conventional mammalian IgG-based immunotherapeutics. The objective of this study was to investigate the potential of alpaca antibodies to neutralise the lethal and procoagulant properties of several Australian elapid snake venoms. Various experimental antivenoms were produced by immunisation of alpaca (Vicugna pacos) with combinations of five Australian elapid snake venoms: tiger snake (Notechis scutatus), eastern brown snake (Pseudonaja textilis), Papuan taipan (Oxyuranus scutellatus canni), mulga snake (Pseudechis australis) and common death adder (Acanthophis antarcticus). Venoms were emulsified in Freund’s Incomplete Adjuvant and alpaca repeatedly immunised. Having previously shown that such alpaca produce persistent venom-specific antibody responses with minimal physiological impact on the animal, the current report demonstrates that polyvalent alpaca antivenom neutralises the lethal effects of three elapid venoms (tiger, brown and Papuan taipan venoms). Such lethality neutralisation was, however, of generally lower potency, but of the same order of magnitude, when compared with bioCSL monovalent antivenoms (brown, tiger and taipan antivenoms). By contrast, the monovalent alpaca tiger and brown snake antivenom were found to be superior to the equivalent bioCSL monovalent antivenoms when considering the neutralisation of the procoagulant effects of the respective immunising venoms. The bioCSL polyvalent antivenom also less potent, when compared with the alpaca taipan monovalent antivenom, against Papuan taipan venom procoagulant neutralisation. These findings support the potential of camelid immunoglobulin for the development of novel elapid specific antivenoms.

A fatal outcome of a presumed tiger snake (Notechis scutatus) envenomation in a cat is described. Detectable venom components and antivenom concentrations in serum from clotted and centrifuged whole blood and urine were measured using a sensitive and specific ELISA. The cat presented in a paralysed state with a markedly elevated serum CK but with normal clotting times. The cat was treated with intravenous fluids and received two vials of equine whole IgG bivalent (tiger and brown snake) antivenom. Despite treatment the cat's condition did not improve and it died 36 h post-presentation. Serum concentration of detectable tiger snake venom components at initial presentation was 311 ng/mL and urine 832 ng/mL, this declined to non-detectable levels in serum 15-min after intravenous antivenom. Urine concentration of detectable tiger snake venom components declined to 22 ng/mL at post-mortem. Measurement of equine anti-tiger snake venom specific antibody demonstrated a concentration of 7.2 Units/mL in serum at post-mortem which had declined from an initial high of 13 Units/mL at 15-min post-antivenom. The ELISA data demonstrated the complete clearance of detectable venom components from serum with no recurrence in the post-mortem samples. Antivenom concentrations in serum at initial presentation were at least 100-fold higher than theoretically required to neutralise the circulating concentrations of venom. Despite the fatal outcome in this case it was concluded that this was unlikely that is was due to insufficient antivenom.

This report describes a confirmed clinical case of tiger snake (Notechis scutatus) envenomation in a domestic dog that was successfully treated with a novel polyvalent camelid (alpaca; Llama pacos) antivenom. Samples collected from the dog were assayed for tiger snake venom (TSV) using a highly sensitive and specific ELISA. The TSV concentration in serum and urine at initial presentation was 365 ng/mL and 11,640 ng/mL respectively. At the time of initial presentation whole blood collected from the dog did not clot and the Prothrombin Time was abnormally increased (>300 s). Serum was also visibly hemolysed. The dog was administered antihistamine, dexamethasone and 4000 Units (sufficient to neutralise 40 mg of TSV) of a novel polyvalent alpaca antivenom diluted in 0.9% NaCl. At 4 h post-antivenom treatment the dog's clinical condition had improved markedly with serum TSV concentrations below the limit of detection (<0.015 ng/mL), consistent with complete binding of venom antigens by the alpaca antivenom. Coagulation parameters had begun to improve by 4 h and had fully normalised by 16 h post-antivenom. Venom concentrations in both serum and urine remained undetectable at 16 h post-antivenom. The dog made a complete recovery, without complications, suggesting that the alpaca-based antivenom is both clinically safe and effective.

Loss of sense of smell is an intriguing yet under-recognised complication of snakebite. We report olfactory function testing and neuroimaging of the olfactory bulbs in a 30-year-old man with anosmia persisting for more than 1year after mulga (Pseudechis australis) snakebite. This problem was first noted by the patient 1week after being definitely bitten in Queensland, Australia. He had then presented to a regional hospital where his envenomation was considered mild enough to not warrant antivenom administration. A week later the patient noted a reduction of sense of smell, which progressed to complete inability to smell over the ensuing weeks. On clinical review the patient's neurologic and rhinologic examination did not reveal any structural cause for anosmia. Formal olfactory testing was performed using ''sniffin' sticks" and the patient scored 17 on this test, indicating severe hyposmia (functional anosmia <16.5, normal score >30.3 for men aged 16-35yea...

Sustainable partnership formation in a remote Indigenous community involves social, cultural and political considerations. This article reports on the project, ‘Sharing Place, Learning Together: Supporting Sustainable Educational Partnerships to Advance Social Equity’, funded by the Melbourne Social Equity Institute (MSEI) at the University of Melbourne (UoM). The project's aims were to document insights into working with communities and educators in a remote community school in Western Arnhem Land, and to promote and raise Aboriginal students’ aspirations for engagement in further education through knowledge exchanges. Two project deliverables focus this paper: a participatory workshop conducted at UoM by educators and students from the school, and a qualitative research study that investigated the mutual partnership capacity building between the school community and UoM. The workshop provided an environment conducive to the participants sharing their cultural knowledge and per...

The venom proteomes of populations of the highly venomous taipan snake, Oxyuranus scutellatus, from Australia and Papua New Guinea (PNG), were characterized by reverse-phase HPLC fractionation, followed by analysis of chromatographic fractions by SDS-PAGE, N-terminal sequencing, MALDI-TOF mass fingerprinting, and collision-induced dissociation tandem mass spectrometry of tryptic peptides. Proteins belonging to the following seven protein families were identified in the two venoms: phospholipase A(2) (PLA(2)), Kunitz-type inhibitor, metalloproteinase (SVMP), three-finger toxin (3FTx), serine proteinase, cysteine-rich secretory proteins (CRISP), and coagulation factor V-like protein. In addition, C-type lectin/lectin-like protein and venom natriuretic peptide were identified in the venom of specimens from PNG. PLA(2)s comprised more than 65% of the venoms of these two populations. Antivenoms generated against the venoms of these populations showed a pattern of cross-neutralization, corroborating the immunological kinship of these venoms. Toxicity experiments performed in mice suggest that, at low venom doses, neurotoxicity leading to respiratory paralysis represents the predominant mechanism of prey immobilization and death. However, at high doses, such as those injected in natural bites, intravascular thrombosis due to the action of the prothrombin activator may constitute a potent and very rapid mechanism for killing prey.

The development of snake antivenoms more than a century ago should have heralded effective treatment of the scourge of snakebite envenoming in impoverished, mostly rural populations around the world. That snakebite still exists today, as a widely untreated illness that maims, kills and terrifies men, women and children in vulnerable communities, is a cruel anachronism. Antivenom can be an effective, safe and affordable treatment for snakebites, but apathy, inaction and the politicisation of public health have marginalised both the problem (making snakebite arguably the most neglected of all neglected tropical diseases) and its solution. For lack of any coordinated approach, provision of antivenoms has been pushed off the public health agenda, leading to an incongruous decline in demand for these crucial antidotes, excused and fed by new priorities, an absence of epidemiological data, and a poor regulatory framework. These factors facilitated the infiltration of poor quality products...

PurposeWithin the context of a review of a Doctor of Medicine graduate curriculum, medical students partnered with faculty staff to co-develop a novel curriculum resource exemplifying the integration of planetary determinants of health into existing medical curricula.MethodWe undertook qualitative methodologies involving a planetary health literature review and curriculum mapping exercise in three parts between April 2018 - May 2021. In part one, a student focus group sought students’ perceptions on opportunities for climate-change related teaching. Part two involved two 5-hour workshops that mapped planetary health principles to classical organ systems-based teaching areas. Part three consisted of curriculum mapping expert review.ResultsParticipatory workshops involved 26 students and positioned students as leaders and partners in curriculum development alongside academics and clinicians. Final synthesis produced a comprehensive infographic rich document covering seven organ system...

UyCT peptides are antimicrobial peptides isolated from the venom of the Australian scorpion. The activity of the UyCT peptides against Gram positive and Gram negative bacteria and red blood cells was determined. The membrane interactions of these peptides were evaluated by dye release (DR) of the fluorophore calcein from liposomes and isothermal titration calorimetry (ITC); and their secondary structure was determined by circular dichroism (CD). Three different lipid systems were used to mimic red blood cells, Escherichia coli and Staphylococcus aureus membranes. UyCT peptides exhibited broad spectrum antimicrobial activity with low MIC for S. aureus and multi-drug resistant Gram negative strains. Peptide combinations showed some synergy enhancing their potency but not hemolytic activity. The UyCT peptides adopted a helical structure in lipid environments and DR results confirmed that the mechanism of action is by disrupting the membrane. ITC data indicated that UyCT peptides preferred prokaryotic rather than eukaryotic membranes. The overall results suggest that UyCT peptides could be pharmaceutical leads for the treatment of Gram negative multiresistant bacterial infections, especially against Acinetobacter baumanni, and candidates for peptidomimetics to enhance their potency and minimize hemolysis. This article is part of a Special Issue entitled: Interfacially Active Peptides and Proteins. Guest Editors: William C. Wimley and Kalina Hristova.

We describe the first Steatoda capensis envenomation treated with CSL red-back spider antivenom (RBSAV). The patient, a 51-year-old female, developed acute local pain, swelling, redness, and diaphoresis in association with tender lymphadenopathy and hypertension. These features responded, in a dose-dependent manner, to RBSAV. In vitro studies confirmed that RBSAV could neutralize S. capensis venom at equivalent concentrations required to neutralize red-back spider (Latrodectus hasselti) venom. Similar data were obtained using Mexican Latrodectus mactans antivenom (Aracmyn®). Although S. capensis yielded similar quantities of venom protein as L. hasselti, pooled S. capensis and Steatoda grossa venom was more rapidly toxic to insects than either L. hasselti or Latrodectus tredecimguttatus venom. By contrast, both Latrodectus venoms were more potent than S. capensis venom in contracting rat isolated mesenteric arteries. Size-exclusion and anion-exchange chromatography was used to purify a 130 kDa fraction from S. capensis venom that induced contracture and loss of twitch tension in chick isolated biventer cervicis nerve-muscle preparations in a manner similar to α-latrotoxin. This activity was abolished by pre-incubation with RBSAV. We conclude that 'steatodism' may overlap more closely with latrodectism than previously recognized and that this bite should be managed in the same way as for Australian red-back envenomation.

Clinicians have for a long time witnessed the tragedy of injury, disability, and death from snake bite that is a daily occurrence in many parts of Africa, Asia, and Latin America. To many people living in these regions, including some of the world's poorest communities, snake bite is ...

A review of the recent foundation by The Australasian College of Tropical Medicine of the Australasian Faculty of Travel Medicine is presented. Information is given on aims, professional grades of membership, and the various activities of the Faculty, including publications and scientific meetings.

... 1984; Southcott 1988; Langley & Morrow 1997). ... However, the 1999 National Academy of Sciences report on'Injuries in America'(Bonnie et al. 1999) recommended expanding its scope to include all injuries which would then provide valuable information on a national basis. ...

We want to discuss antivenom use in snakebite clinical practice guidelines. Coronial reviews in Victoria of two cases of snakebite envenomation, one described in detail below, prompted us to submit this paper for a wider audience and debate. Venom and antivenom levels were measured in the case detailed below, but not in the other. The coroner received conflicting and varied advice from experts regarding the dose of anti-venom. The Victorian Department of Health and Human Services and the Australasian College for Emergency Medicine were instructed to review snakebite management guidelines, particularly with respect to anti-venom dosage. The discussion that took place among medical experts led to considerable media attention. We discuss the potential fallout when there is no consensus among medical experts.

Sustainable partnership formation in a remote Indigenous community involves social, cultural and political considerations. This article reports on the project, ‘Sharing Place, Learning Together: Supporting Sustainable Educational Partnerships to Advance Social Equity’, funded by the Melbourne Social Equity Institute (MSEI) at the University of Melbourne (UoM). The project’s aims were to document insights into working with communities and educators in a remote community school in Western Arnhem Land, and to promote and raise Aboriginal students’ aspirations for engagement in further education through knowledge exchanges. Two project deliverables focus this paper: a participatory workshop conducted at UoM by educators and students from the school, and a qualitative research study that investigated the mutual partnership capacity building between the school community and UoM. The workshop provided an environment conducive to the participants sharing their cultural knowledge and perspectives on a two-way Learning on Country program with the wider UoM community. Extensive interview data collected from school and community-based participants identified the enabling and constraining factors impacting the formation of a sustainable partnership. The findings revealed the importance of prioritising relationship-building, the valuing of resource development, and the need for humility and openness to criticism when working with remote communities.

Sharing Place, Learning Together (SPLT) is a cross-disciplinary education project that aims to develop the English and Science literacy skills of remote Aboriginal students. The project comprises an interdisciplinary team from the University of Melbourne (UoM) partnering with Maningrida College and the Djelk Rangers (Bawaninga Aboriginal Corporation) to support the College’s ‘Learning on Country’ program. Through cross-cultural exchanges and ‘on country’ visits Aboriginal biocultural knowledge is integrated with Western scientific understanding to develop curriculum and literacy resources. This paper details SPLT’s evolvement and discusses activities and learning experiences the partnership has generated. Linked to the project’s development, the paper presents the findings of a research study that investigated mutual capacity and partnership building between the Maningrida College Community and UoM. These findings reveal that relationship-building, coupled with a sustained presence in the community, were critical to strengthening the partnership, and highlighted that establishing trust and credibility must precede research initiatives.

Alpaca (Vicugna pacos), like all other members of the camelid family, produce a unique heavy chain only IgG subclass. This form of IgG has been proposed as having superior neutralising properties and improved safety as compared with conventional mammalian IgG-based immunotherapeutics. The objective of this study was to investigate the potential of alpaca antibodies to neutralise the lethal and procoagulant properties of several Australian elapid snake venoms. Various experimental antivenoms were produced by immunisation of alpaca (Vicugna pacos) with combinations of five Australian elapid snake venoms: tiger snake (Notechis scutatus), eastern brown snake (Pseudonaja textilis), Papuan taipan (Oxyuranus scutellatus canni), mulga snake (Pseudechis australis) and common death adder (Acanthophis antarcticus). Venoms were emulsified in Freund's Incomplete Adjuvant and alpaca repeatedly immunised. Having previously shown that such alpaca produce persistent venom-specific antibody responses with minimal physiological impact on the animal, the current report demonstrates that polyvalent alpaca antivenom neutralises the lethal effects of three elapid venoms (tiger, brown and Papuan taipan venoms). Such lethality neutral-isation was, however, of generally lower potency, but of the same order of magnitude, when compared with bioCSL monovalent antivenoms (brown, tiger and taipan antivenoms). By contrast, the monovalent alpaca tiger and brown snake antivenom were found to be superior to the equivalent bioCSL monovalent antivenoms when considering the neutralisation of the procoagulant effects of the respective immunising venoms. The bioCSL polyvalent antivenom also less potent, when compared with the alpaca taipan mono-valent antivenom, against Papuan taipan venom procoagulant neutralisation. These findings support the potential of camelid immunoglobulin for the development of novel elapid specific antivenoms.

This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/authorsrights a b s t r a c t A fatal outcome of a presumed tiger snake (Notechis scutatus) envenomation in a cat is described. Detectable venom components and antivenom concentrations in serum from clotted and centrifuged whole blood and urine were measured using a sensitive and specific ELISA. The cat presented in a paralysed state with a markedly elevated serum CK but with normal clotting times. The cat was treated with intravenous fluids and received two vials of equine whole IgG bivalent (tiger and brown snake) antivenom. Despite treatment the cat's condition did not improve and it died 36 h post-presentation. Serum concentration of detectable tiger snake venom components at initial presentation was 311 ng/ mL and urine 832 ng/mL, this declined to non-detectable levels in serum 15-min after intravenous an-tivenom. Urine concentration of detectable tiger snake venom components declined to 22 ng/mL at post-mortem. Measurement of equine anti-tiger snake venom specific antibody demonstrated a concentration of 7.2 Units/mL in serum at post-mortem which had declined from an initial high of 13 Units/mL at 15-min post-antivenom. The ELISA data demonstrated the complete clearance of detectable venom components from serum with no recurrence in the post-mortem samples. Antivenom concentrations in serum at initial presentation were at least 100-fold higher than theoretically required to neutralise the circulating concentrations of venom. Despite the fatal outcome in this case it was concluded that this was unlikely that is was due to insufficient antivenom.

This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the author's institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/authorsrights

Diagnosis and management of venomous bites and stings, particularly snakebite, is important for Australian clinicians. In 2015, a flipped classroom was trialled to teach the principles of envenomation to year 1 medical students in a MD program. A bespoke online resource was developed and then used by students to prepare for a face-to-face class tailored to their learning needs. Students reported positively about learning the principles of envenomation with the online resource and found it useful. Responses from students also indicated that the interactive class was beneficial to their learning, particularly the clinical application of envenomation. These findings were supported by comparisons of pre-and post-test scores that showed significant learning gains across eight questions. The study also provided some insights into students' perception of knowledge retention and why some students may prefer to prepare individually for content attainment.

Loss of sense of smell is an intriguing yet under-recognised complication of snakebite. We report olfactory function testing and neuroimaging of the olfactory bulbs in a 30-year-old man with anosmia persisting for more than 1 year after mulga (Pseudechis australis) snakebite. This problem was first noted by the patient 1 week after being definitely bitten in Queensland, Australia. He had then presented to a regional hospital where his envenomation was considered mild enough to not warrant antivenom administration. A week later the patient noted a reduction of sense of smell, which progressed to complete inability to smell over the ensuing weeks. On clinical review the patient's neurologic and rhinologic examination did not reveal any structural cause for anosmia. Formal olfactory testing was performed using ''sniffin' sticks " and the patient scored 17 on this test, indicating severe hyposmia (functional anosmia <16.5, normal score >30.3 for men aged 16–35 years). MRI of the brain showed no abnormalities. The olfactory bulb volumes were then measured on a volumetric T2-weighted MRI that demonstrated significantly reduced volume of both bulbs, with the right 34.86 mm 3 and left 36.25 mm 3 (normal volume P58 mm 3 , 10th centile). The current patient represents a rare instance of a definite, untreated, elapid (mulga snake) envenomation with an intriguing disjunction between the mildness of the systemic features and the severity of the olfactory lesion. It is also unclear if early antivenom use attenuates this condition, and due to the delayed manifestation of the symptoms, awareness of this phenomenon may be lacking amongst physicians.

This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/authorsrights a b s t r a c t The Snake Venom Detection Kit (SVDK; bioCSL Pty Ltd, Australia) distinguishes venom from the five most medically significant snake immunotypes found in Australia. This study assesses the rate of false posi-tives that, by definition, refers to a positive assay finding in a sample from someone who has not been bitten by a venomous snake. Control unbroken skin swabs, simulated bite swabs and urine specimens were collected from 61 healthy adult volunteers [33 males and 28 females] for assessment. In all controls, simulated bite site and urine samples [a total of 183 tests], the positive control well reacted strongly within one minute and no test wells reacted during the ten minute incubation period. However, in two urine tests, the negative control well gave a positive reaction (indicating an uninterpretable test). A 95% confidence interval for the false positive rate, on a per-patient rate, derived from the findings of this study, would extend from 0% to 6% and, on a pertest basis, it would be 0e2%. It appears to be a very low incidence (0e6%) of intrinsic true false positives for the SVDK. The clinical impresssion of a high SVDK false positive rate may be mostly related to operator error. Crown

Alpaca (Vicugna pacos) are domesticated members of the camelid family that have been shown to produce an IgG subclass that is heavy chain only IgG. This camelid-type IgG has been postulated to have improved neutralising properties and reduced immunogenicity, compared with conventional mammalian IgG. This study was undertaken to describe the physiological and antibody responses of alpaca (Vicugna pacos) used for the production of an experimental camelid antivenom. Various antivenom products were developed by immunisation of alpaca with combinations of five Australian elapid snake venoms: common tiger snake (Notechis scutatus), eastern brown snake (Pseudonaja textilis), Papuan taipan (Oxyuranus scutellatus canni), mulga snake (Pseudechis australis) and common death adder (Acanthophis antarcticus) were emul-sified with Freund's Adjuvant and injected monthly using a low dose multi-site approach. Venom specific immune responses were monitored by ELISA. Physiological effects upon alpaca were monitored by clinical examination combined with serial haematology and biochemical profiles. Serum was harvested once immune responses had peaked and the IgG fraction concentrated by ammonium sulphate precipitate of non-IgG proteins. Total serum IgG and total serum protein concentrations increased and decreased in synchrony with boosting specific antibodies. The difference in serum creatinine kinase concentration measured at 24 h after each of the first three immunisations decreased as the alpaca mounted an anti-body response to the venom antigens measured by ELISA. In conclusion, alpaca responded to repeated immunisation with various Australian elapid venoms by mounting an increasing antibody response that persisted following prolonged rest with minimal physiological impact on the animal.

This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/authorsrights

Numerous terrestrial and marine animals envenomate or poi- son human victims around the world causing characteristic syndromes. Children are overrepresented among the victims of envenomation. Many envenomation syndromes threaten life and cause serious illness. Treatment in some syndromes requires only mechanical ventilation and intensive cardiovas- cular support, but others may require specific therapies includ- ing the administration of antivenom. This chapter describes the animals, their toxins or poisons, the injuries which they cause, and outlines treatment appropriate for each. The sites of action of toxins and poisons on neuromuscular function are given in Figure 37.1.