Cases of snakebites especially with an elapidae are considered as a medical emergency. However, in some cases of elapidae envenomation, bite signs might be unpredictable. Case: Dorsal surface of the second finger of a 39-year-old man was bitten by N. Naja Oxiana less than half hour before his admission. On arrival, patient had clear bilateral ptosis, mydriasis, reduced light reflex of pupils and sialorrhea. Other muscles power had no problem. The patient was agitated due to suffocation secondary to respiratory muscle paralysis, during half hours of hospitalization. He was intubated and mechanically ventilated. He was treated by antivenom, 10 vials as attack dose, 5 vials as repeated dose that was repeated three times and 2 vials every 8 hours as maintenance dose. He received antibiotic for local superinfection. Although, he did not receive any acetylcholinesterase inhibitors, he was extubated 48 hours later. The patient was discharged on the 7 th day in good general condition with oral antibiotic prescription and no complication except local cellulitis. In conclusion, for efficient treatment of patients bitten with elapidae, we need to find the best course of treatment using the adequate antivenom as fast as possible.

The aim of this study is to investigate antibacterial effects of immunodominant proteins isolated from the venom of Naja Naja Oxiana snake against Staphylococcus aureus, Escherichia coli, Bacillus subtilis and Pseudomonas aeruginosa. The innate immune system is an important line of defense against bacterial diseases. Antibacterial peptides and proteins produced by snake venoms have recently attracted significant attention due to their relevance to bacterial diseases and the potential of being converted into new therapeutic agents. Identification of immunodominant proteins of the venom of Naja Naja Oxiana snake was performed by SDS-PAGE and western blot analysis. Identified proteins were isolated directly from preparative gel electrophoresis by Electro- elution. In the next step, antibacterial effects of immunodominant proteins were tested against several strains of clinical isolates, including S.aureus, B. subtilis (Gram-positive bacteria) P. aeruginosa and E.coli (Gram-negative bacteria) using broth microdilution and disc- diffusion assays. In order to compare the results of the disc-diffusion assay, antibacterial effects of several antibiotics (Gentamicin, Ampicillin, Penicillin, Amoxicillin and Ciprofloxacin) were also examined using the same conditions.Results showed that immunodominant proteins of (14, and 65kDa) with high immunogenicity were very effective in inhibiting the growth of two Gram- positive bacteria (S.aureus, B.sub) that were tested. However, they were only moderately effective in inhibiting the growth of the two tested Gram- negative bacteria (P.aeruginosa and E.coli). However, immunodominant proteins of 22 kDa and 32kDa with high immunogenicity, showed slight effectiveness in inhibiting the growth of two; the Gram-positive and Gram-negative bacteria that were tested. To the best of our knowledge, these immunodominant proteins are novel antigens for potent antimicrobial effects against two gram-positive bacteria (S.aureus, B. subtilis) and less antimicrobial effect against two gram-negative bacteria (E.coli, P. aeruginosa) that were prepared.

Conventional treatment of Naja naja oxiana (NNO) envenoming requires large volumes of equine antivenin raised against NNO crude venom. The poor efficiency of this antivenin is assumed to be due to the high molecular weight non-toxic proteins, a strong immunogen, present in the crude venom. These proteins cause depression of antibody formation against the low molecular weight toxic components of venom. In the present study the low molecular weight lethal components were isolated from crude venom of NNO venom by sephadex G50 get filtration chromatography. A sera was prepared by immunizing horses with toxic fraction. One milliliter of this serum neutralized 1.8mg of NNO crude venom. This high titer antivenin is thus 2.2 times more potent than the sera obtained against NNO crude venom.

The myocardial effect of snake venoms is considered as one of the most common pathogenesis in many cases of snake envenomation. This study was undertaken to investigate the effects of the Iranian cobra (Naja naja oxiana) venom on cardiac function in experimental animals. The blood samples from all the rabbits were collected before venom injection, and then 140 μ g kg-1 venom of snake (Naja naja oxiana) was injected intramuscularly to the rabbits. Following venom injection the blood was collected again at 1, 3 and 24 h. Electrocardiogram (ECG) was recorded during the experiment. The levels of serum enzymes lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB) and creatine phosphokinase (CPK) were determined. Statistical analyses were carried out by SPSS version 21 software. CPK enzyme showed a significant increase at 1 and 3 h after venom injection. The level of CK-MB also rose significantly after 1 h following venom injection. However, even at 24 h the level of CPK was not changed significantly, and the rise in CK-MB at 3 and 24 h following venom injection was not significant statistically. Although there was a rise in LDH level following venom injection but it was not significant. The ECG also confirmed changes in heart rhythmic and showed bradycardia and T tall. Based on the results obtained in the present study, it seems that the Naja naja oxiana venom has acute effect on cardiac system during the first few hours of snake bite.

One small-scale double emulsion technique for incorporation of Naja- Naja oxiana venom into Poly (lactide-co-glycolide) (PLGA) microspheres were developed and optimized. The effects of high speed homogenization on the double emulsion stability, microsphere size, entrapment efficiency and In vitro release of venom were studied. A stable double emulsion was verified by homogenization method. Slow removal of the organic phase allowed measurement of the size of the emulsion droplets and subsequent predication of the size which resulting microspheres. Microspheres in the size range of 1-10 mm were prepared using homogenization technique, but this technique was sensitive to changes in the operating time, speed and volume of outer aqueous phase. Snake venom was released in vitro in a triphasic manner. After immunization of guinea–pig with a single IM injection, the PLGA-venom microspheres elicited an antibody response very high as that elicited with conventional method. These results indicate that the antigenicity of venom was retained after incorporation into PLGA microspheres using homogenization technique.