Limited efficacy of cold and heat therapy as adjunctive treatments for local and functional outcomes of Bothrops atrox snakebite envenomation: A randomized clinical trial.
<h4>Background</h4>Bothrops atrox envenomation can cause significant local and systemic effects. Adjunctive therapies, such as cold and heat applications, are proposed to enhance antivenom efficacy, but their clinical value remains unclear.<h4>Methods</h4>This randomized, thr...
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| Format: | Article |
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Public Library of Science (PLoS)
2025-08-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | https://doi.org/10.1371/journal.pntd.0013423 |
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| author | Mailma Costa de Almeida Kathleen Maclenny Pereira Carvalho Yasmim da Silva Mendes Debora Nery Oliveira Érica da Silva Carvalho Marco Aurélio Sartim Felipe Queiroz Araújo André Sachett João Ricardo Nickenig Vissoci Fernando Almeida-Val Daniel Barros de Castro Wuelton Monteiro Jacqueline de Almeida Gonçalves Sachett |
| author_facet | Mailma Costa de Almeida Kathleen Maclenny Pereira Carvalho Yasmim da Silva Mendes Debora Nery Oliveira Érica da Silva Carvalho Marco Aurélio Sartim Felipe Queiroz Araújo André Sachett João Ricardo Nickenig Vissoci Fernando Almeida-Val Daniel Barros de Castro Wuelton Monteiro Jacqueline de Almeida Gonçalves Sachett |
| author_sort | Mailma Costa de Almeida |
| collection | DOAJ |
| description | <h4>Background</h4>Bothrops atrox envenomation can cause significant local and systemic effects. Adjunctive therapies, such as cold and heat applications, are proposed to enhance antivenom efficacy, but their clinical value remains unclear.<h4>Methods</h4>This randomized, three-arm clinical trial included 94 patients allocated in a 1:1:1 ratio to Cold Therapy Group (CTG, n = 30), Heat Therapy Group (HTG, n = 31), or Control Group (CG, n = 33). All participants received standard antivenom therapy, with CTG and HTG receiving additional interventions applied for 24 hours post-admission. Primary outcomes included changes in creatine kinase (CK) levels. Secondary outcomes assessed pain intensity, edema, local temperature, and functional recovery using the World Health Organization Disability Assessment Schedule (WHODAS 2.0) assessed four to six months after hospital discharge. Kaplan-Meier survival analysis evaluated time-to-event outcomes.<h4>Findings</h4>Baseline characteristics were comparable across groups. CK levels decreased similarly in all groups at 48 hours (p = 0.89). No significant differences were observed in the reduction of limb circumference, edema extent and bite site temperature, either the ITT or PP analysis. CTG showed a significant reduction in pain within 24 hours in the per-protocol analysis (Log-rank p = 0.04). Disability assessed by WHODAS 2.0 revealed no significant differences between groups after 6 months of follow-up. No adverse events were associated with the interventions.<h4>Interpretation</h4>Adjunctive HTG had no efficacy in treating local effects of B. atrox envenomation. Adjunctive CTG demonstrated benefits observed in pain reduction. |
| format | Article |
| id | doaj-art-ce2309067ece4c51bb51bafb0ba5f5b2 |
| institution | Kabale University |
| issn | 1935-2727 1935-2735 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Neglected Tropical Diseases |
| spelling | doaj-art-ce2309067ece4c51bb51bafb0ba5f5b22025-08-26T05:31:11ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352025-08-01198e001342310.1371/journal.pntd.0013423Limited efficacy of cold and heat therapy as adjunctive treatments for local and functional outcomes of Bothrops atrox snakebite envenomation: A randomized clinical trial.Mailma Costa de AlmeidaKathleen Maclenny Pereira CarvalhoYasmim da Silva MendesDebora Nery OliveiraÉrica da Silva CarvalhoMarco Aurélio SartimFelipe Queiroz AraújoAndré SachettJoão Ricardo Nickenig VissociFernando Almeida-ValDaniel Barros de CastroWuelton MonteiroJacqueline de Almeida Gonçalves Sachett<h4>Background</h4>Bothrops atrox envenomation can cause significant local and systemic effects. Adjunctive therapies, such as cold and heat applications, are proposed to enhance antivenom efficacy, but their clinical value remains unclear.<h4>Methods</h4>This randomized, three-arm clinical trial included 94 patients allocated in a 1:1:1 ratio to Cold Therapy Group (CTG, n = 30), Heat Therapy Group (HTG, n = 31), or Control Group (CG, n = 33). All participants received standard antivenom therapy, with CTG and HTG receiving additional interventions applied for 24 hours post-admission. Primary outcomes included changes in creatine kinase (CK) levels. Secondary outcomes assessed pain intensity, edema, local temperature, and functional recovery using the World Health Organization Disability Assessment Schedule (WHODAS 2.0) assessed four to six months after hospital discharge. Kaplan-Meier survival analysis evaluated time-to-event outcomes.<h4>Findings</h4>Baseline characteristics were comparable across groups. CK levels decreased similarly in all groups at 48 hours (p = 0.89). No significant differences were observed in the reduction of limb circumference, edema extent and bite site temperature, either the ITT or PP analysis. CTG showed a significant reduction in pain within 24 hours in the per-protocol analysis (Log-rank p = 0.04). Disability assessed by WHODAS 2.0 revealed no significant differences between groups after 6 months of follow-up. No adverse events were associated with the interventions.<h4>Interpretation</h4>Adjunctive HTG had no efficacy in treating local effects of B. atrox envenomation. Adjunctive CTG demonstrated benefits observed in pain reduction.https://doi.org/10.1371/journal.pntd.0013423 |
| spellingShingle | Mailma Costa de Almeida Kathleen Maclenny Pereira Carvalho Yasmim da Silva Mendes Debora Nery Oliveira Érica da Silva Carvalho Marco Aurélio Sartim Felipe Queiroz Araújo André Sachett João Ricardo Nickenig Vissoci Fernando Almeida-Val Daniel Barros de Castro Wuelton Monteiro Jacqueline de Almeida Gonçalves Sachett Limited efficacy of cold and heat therapy as adjunctive treatments for local and functional outcomes of Bothrops atrox snakebite envenomation: A randomized clinical trial. PLoS Neglected Tropical Diseases |
| title | Limited efficacy of cold and heat therapy as adjunctive treatments for local and functional outcomes of Bothrops atrox snakebite envenomation: A randomized clinical trial. |
| title_full | Limited efficacy of cold and heat therapy as adjunctive treatments for local and functional outcomes of Bothrops atrox snakebite envenomation: A randomized clinical trial. |
| title_fullStr | Limited efficacy of cold and heat therapy as adjunctive treatments for local and functional outcomes of Bothrops atrox snakebite envenomation: A randomized clinical trial. |
| title_full_unstemmed | Limited efficacy of cold and heat therapy as adjunctive treatments for local and functional outcomes of Bothrops atrox snakebite envenomation: A randomized clinical trial. |
| title_short | Limited efficacy of cold and heat therapy as adjunctive treatments for local and functional outcomes of Bothrops atrox snakebite envenomation: A randomized clinical trial. |
| title_sort | limited efficacy of cold and heat therapy as adjunctive treatments for local and functional outcomes of bothrops atrox snakebite envenomation a randomized clinical trial |
| url | https://doi.org/10.1371/journal.pntd.0013423 |
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