Next, the initial release rate (at t = 0) is used to estimate kS. Last, koff that determines the kinetics of the sustained release is calculated. These estimated parameters (i.e., ΔG, kS, koff) are used as the initial input in Matlab codes to refine the estimations using an optimization method. The properties of the parameter estimates, such as mean and standard deviation, are assessed using bootstrap sampling [28], as detailed Inhibitors,research,lifescience,medical in Section 3.5. 3.2. Drug Release from Liposomes and Nanocapsules Liposomes and lipid nanocapsules (LNC) are among drug delivery systems that first made their way to clinical applications [5]. The bilayered structure of liposomes enables the encapsulation of hydrophilic

and lipophilic drug in their interior aqueous compartments (see more Figure 1(b)) and in the lipid bilayers (Figure 1(c)), respectively [32]. However, liposomes can be easily trapped by the reticuloendothelial system (RES), leading to rapid removal from circulation [33]. A hydrophilic barrier, often formed by polyethylene glycol (PEG) derivatives, Inhibitors,research,lifescience,medical may be created to protect liposomes, avoiding their uptake Inhibitors,research,lifescience,medical by RES [34]. PEGylation of liposomes increased their circulation half-times of about 30 minutes to 5 hours nearly two decades ago [34] to around 10 hours

recently [35], enhancing their spontaneous accumulation in solid tumors [34, 36]. Efforts to control release kinetics made it possible to deplete encapsulated drugs in a time comparable to or longer than the circulation time of liposomes [25, 26]. Here, we simulate drug release Inhibitors,research,lifescience,medical from liposomes and LNC at different time scales (Figures 3(a)–3(d)) and from polymeric

nanocapsules (NC) for comparison (Figures 3(e) and 3(f)). Parameter estimates for the Inhibitors,research,lifescience,medical simulations are listed in Table 1. Table 1 Parameter estimates for simulations in Figure 3. We first simulate the fast release of CF from TSL, triggered by mild hyperthermia (Figure 3(a)). Li et al. [24] designed and synthesized TSL such that its gel-to-liquid transition temperature resided at around 43°C. As a result, TSL was stable at 37°C and capable of retaining encapsulated molecules in the circulation. Once it reached the targeted site, TSL released encapsulated molecules rapidly due to Parvulin the gel-to-liquid transition induced by local hyperthermia. This process can be modulated by PEG addition. For instance, TSL with a high PEG density releases CF faster than TSL with a low PEG density. Our model successfully captures CF release from TSL with different PEG densities at 42°C. In particular, both ΔG and kS increase with PEG density, suggesting that PEGylation not only modifies the permeability of the lipid membrane but also decreases the ability of TSL to interact with hydrophilic molecules. This is consistent with the report [24] that PEG at a high density destabilizes the lipid membrane of TSL and changes the membrane modality for CF release.

05). The SPM toolbox MarsBaR (Brett et al. 2002a,b) and MarsBaR AAL ROI package (Brett et al. 2002a,b) were used to extract parameter estimates for each participant from ROIs. Cluster size and coordinates for peaks of activity for all contrasts of interest are presented in Tables 2–5. Table 2 Significant activity observed in GSK2656157 concentration typically developing

children for each contrast of interest Table 5 Areas showing positive correlations between scales measuring symptom severity in the ASD group and increased activity when viewing “beat gesture with speech” versus “still frame with speech” Results Whole-brain analyses As shown in Tables 2 and ​and3,3, within-group contrasts revealed that both TD and ASD children activated similar Inhibitors,research,lifescience,medical language-relevant frontotemporal networks when responses for conditions involving the presentation of speech were compared with conditions without speech. Likewise, both group contrasts also showed increased activity in visual areas for conditions involving body movement versus conditions involving

a still frame. The overall similar pattern Inhibitors,research,lifescience,medical of activity observed in each group across conditions suggests that both TD and ASD children attended to and processed the relevant Inhibitors,research,lifescience,medical features of our stimuli (but see below and Table 4 for between-group contrasts). Table 3 Significant activity observed in children with ASD for each contrast of interest Table 4 Significant activity observed in between-group comparisons for contrasts of interest With regard to our primary contrast of interest – “beat gesture Inhibitors,research,lifescience,medical with speech” versus “still frame with speech” – both groups showed significantly greater activity in visual cortices (see Tables 2 and ​and3).3). However, in addition to the extensive increased activity observed in visual areas, significant activity was also observed in right posterior STG and sulcus (STG/S) for the TD group and in bilateral posterior middle and inferior temporal gyri for the ASD group. A direct between-group comparison for this contrast revealed significantly greater activity in TD than ASD children in the right STG/S and middle temporal gyrus (MTG), and greater activity Inhibitors,research,lifescience,medical in ASD than

TD children in lingual gyrus, calcarine only fissure, and cuneus (see Fig. 2b and c). Figure 2 Differences in neural activity for ASD and TD groups related to processing “still frame with speech” and “beat gesture with speech.” Clusters depict areas of significantly greater activity while viewing “beat gesture … The significant between-group differences observed when speech was accompanied by beat gesture were not observed when speech was accompanied by nonsense hand movement. Within-group analyses for both the TD and ASD groups showed that bilateral middle and inferior occipital gyri as well as bilateral posterior middle and inferior temporal gyri were more active while viewing “nonsense hand movement with speech” (vs. “still frame with speech”; see Tables 2 and ​and3).3).

5% (Fig. 5B). This classifier performed significantly better than a random classifier (McNemar χ2 = 6.54, P < 0.05). Discussion The findings presented here constitute an initial attempt to apply fundamental concepts from IR to the AD problem set. Techniques borrowed from IR include (1) arrangement of PET scans in a vector space, with one dimension for each PET scan voxel, (2) refinement of queries by subtraction Inhibitors,research,lifescience,medical of orthogonal vectors (a technique used to implement a logical NOT operation for search

engines—see Widdows 2004; Widdows and Peters 2003), and (3) scoring of PET scan “relevance” to a diagnostic query by means of cosine similarity between vectors. Cosine similarity scores derived in this manner are useful for constructing classifiers that differentiate NC subjects from AD subjects, as well as MCI patients who are destined to convert to AD within 2 years from those who are not. Furthermore, both types of cosine similarity scores derived here make independent IKK inhibitor mouse contributions to Inhibitors,research,lifescience,medical variance in follow-up FAQ scores that supersede

the contribution of diagnostic group, suggesting that this method may be useful for making more precise prognostications regarding the functional status of individuals. The validity of the method is given further support by the Inhibitors,research,lifescience,medical fact that the residual vectors bear a Inhibitors,research,lifescience,medical topographic resemblance to maps of the default mode network. The method is computationally simple, at least relative to many techniques commonly run on modern computers. Ordinary least squares regression (the first step for computing the residual vectors) is a common approach to finding approximate Inhibitors,research,lifescience,medical solutions to many problems in statistics and engineering. Accordingly, algorithms for regression are fast and implementations are convenient. In MATLAB®, the regression step takes only one line of code and usually runs in less than

1 sec, even with large matrices. Classifiers built from structural MRI data that discern between controls and AD patients have similar accuracy to the ones presented here, but are much more computationally intensive, sometimes requiring from more than 1 week to build the classifier and hours to test it (Cuingnet et al. 2010). The method presented here compares favorably with other methods. Classifiers built from structural MRI data alone perform well when differentiating between patients with AD and subjects with normal cognition (up to 81% sensitivity with 95% specificity for voxel-based methods) (Cuingnet et al. 2010). Some studies have reported comparable accuracy with MRI methods for predicting conversion from MCI to AD, but sample sizes have been small and lack of cross-validation may mean that the results will not generalize to other samples (Convit et al. 2000).

conclusive, because BPD per se is correlated with all kinds of somatic disorders, including dementia, cerebrovascular disorders, diabetes, hypertension, etc.98 Early recognition of bipolarity The

early recognition and treatment of bipolarity is essential for preventing the serious social consequences, rapid cycling, chronicity, and suicidally associated with it, as well as for reducing Inhibitors,research,lifescience,medical the economic costs, as shown by McCombs et al.99 It has already been stressed that there is a. serious gap in our knowledge about, the onset, of BPD in child psychiatry; the timely diagnosis of BPD raises unsolved ABT-888 solubility dmso problems in adult psychiatry, as well. Hauser et al100 recently summarized the present, difficulties in recognizing Inhibitors,research,lifescience,medical bipolarity. The authors concluded that we need validated thresholds for true caseness on temperamental measures such as the TEMPS-A scale, we require more data on frequent “ups and downs” as a strong correlate of bipolar disorder, and we need intensive research on hypomanic symptoms without restrictions as to the minimal duration or the consequences of the symptoms. We should not, however, Inhibitors,research,lifescience,medical mix trait measures (TEMPS-A) with state measures. Screening tools for hypomania The well-recognized difficulties of identifying bipolarity have led to the development, of modern screening tools for the self-assessment of hypomanic/manic symptoms, a development, which is still in its early stages. The bestknown instrument,

is the mood

disorder questionnaire (MDQ) of Hirschfeld et al,101 fitting DSM-IV criteria for mania and hypomania. Another was derived from a symptom checklist, of 20 hypomanic symptoms, used since 1986 in the interviews Inhibitors,research,lifescience,medical of the Zurich Study, and applied successfully by Hantouche as the self-assessment hypomania checklist HCL-20 in several large French studies.8,102,103 In the EPIDEP Inhibitors,research,lifescience,medical study,98 the rate of BP-II among patients originally diagnosed with MDE almost doubled when they were screened with the H.CL-201 month later. The Hypomania Checklist-32104 is an extended version of the instrument; it. has been translated into more than 20 languages (available GPX6 on request) and underwent recently a first, revision (HCL-32 R-1). It is currently being validated in different, cultures, in order to ascertain whether there are universal core symptoms. A recent Taiwanese study105 identified the same two-factor structure of hypomania as found in earlier studies carried out, in Italy and Sweden104 and Spain.106 A future task will be to identify a. factor solution which is cross-culturally stable. A cutoff of 10 on the H.CL-20 and of 14 on the HCL-32 seems to identify a. large proportion of MDE, cases as bipolar patients. Conclusions This article illustrates that conclusive clinical research into bipolar disorder still has a. long way to go. We need more and longer representative prospective studies in children, adolescents, and adults.

HSF1 controls physiological processes that are temporarily dispensable, such as cell cycle activities, and is essential for the cell’s recovery from short, high-intensity heat shock. By contrast, MSN seems to be primarily in charge of long-term survival at high, but tolerable temperatures [14]. A good review, although not recent, can be found in this reference [9]. One should note that heat affects the regulation of a number of genes that code for enzymes involved in central carbon metabolism. Two modes of action seem to play a role: Some steps are Inhibitors,research,lifescience,medical catalyzed by more than

one protein paralog, in which case some of the paralogs are heat-inducible while the others are not (Table 1). Additionally, all genes coding for producing and degrading enzymes in some metabolic cycles (e.g., Selleck LY2157299 trehalose or glycogen) are up-regulated, which hints at the existence of downstream regulatory processes. Table

1 Differentially regulated protein paralogs Inhibitors,research,lifescience,medical (adapted from [1]). (3) Effects of protein unfolding on the rapid production of protective metabolites. Heat-induced protein unfolding, directly affects events at the metabolic Inhibitors,research,lifescience,medical level. In particular, temperature alters the activity of several enzymes of the trehalose pathway, thereby leading to the accumulation of the disaccharide trehalose, which protects proteins, membranes and DNA from damage. Intriguingly, Inhibitors,research,lifescience,medical heat stress induces a simultaneous increase in the expression of genes coding for both the synthesis and degradation of trehalose,

glycogen and fructose-2,6-biphosphate [1]. This increased capacity for production and degradation of intermediates is at first puzzling, and one might be tempted to conclude that it constitutes a futile cycle. However, Inhibitors,research,lifescience,medical it rather appears to be evidence of a downstream regulatory mechanism. Such a mechanism can be inferred very nicely from the case of trehalose. Here, the producing enzymes (trehalose 6-phosphate synthase and phosphatase; Tps1p and Tps2p) have activity optima at temperatures of 35–45 °C, whereas the degrading enzyme (trehalase; Nth1p) has its optimum temperature at 30 °C [15]. With this discrepancy in optimal temperatures, very little trehalose is produced at 30 °C, and because trehalase is at its maximum activity, no trehalose accumulates. However, ADP ribosylation factor at 40 °C, trehalose production is high and the trehalase activity is reduced by a factor of ~2.4, which causes trehalose to accumulate. Once the temperature returns to normal values, the direct temperature dependence of these enzyme activities allows the cell immediately to degrade all trehalose accumulated at the higher temperature. Not to be wasteful, this degraded trehalose enters glycolysis in the form of two molecules of glucose.

On the basis of the results it can be concluded that the presence of DOTAP leads to significant (P < 0.05) higher Casein Kinase inhibitor encapsulation efficiency with DOPC and POPC as main lipid component. LEC liposomes demonstrated the least encapsulation efficiency for DTO, and DOTAP appeared to provide little to no enhancement (Table 3). The role of DOTAP in enhancing the encapsulation efficiency can be explained with electrostatic interactions between DOTAP and DTO at the pH value examined (pH = 7.4). Early experiments with the 60:40 ratio of dipalmitoyl-phosphatidylcholine

(DPPC) to Chol composition provided very low encapsulation efficiency Inhibitors,research,lifescience,medical for encapsulation of DTO (data not shown here). As DTO is a lipophilic sulfur donor, it can be expected that it is localized in the liposomal bilayer, Inhibitors,research,lifescience,medical more or less immersed in it. The saturated bonds of DPPC providing an ordered, relative rigid structure may inhibit the immersion of DTO in the liposomal membrane. Contrarily, POPC and DOPC possessing double bonds and as a consequent of it a less ordered and more fluid membrane structure can promote the encapsulation Inhibitors,research,lifescience,medical of DTO. Thus, instead of DPPC, DOPC, or POPC were used for liposome

preparation and ratios were adjusted to 90:10 lipid to Chol. The results shown in Table 3 indicate that DOPC liposomes containing 3mol% DOTAP provided the highest encapsulation efficiency at 81.7 ± 3.1%. POPC liposomes Inhibitors,research,lifescience,medical with 3% DOTAP were close behind with an encapsulation efficiency of 78.4 ± 2.3%. However, there was no significant difference between encapsulation efficiencies with DOPC and POPC. Table 3 Encapsulation efficiencies for DTO in various liposome compositions with and without DOTAP. DTO concentration was 2.0mM. Total lipid concentration was 10.0mg/mL. The liposome compositions

Inhibitors,research,lifescience,medical including DOTAP were used in further experiments due to the increase in encapsulation efficiency achieved by these films. The effect on encapsulation efficiency by the increase in DTO concentration was evaluated for DOPC and POPC containing liposome compositions with both sets of liposomes containing 3% DOTAP. In order to evaluate the role of DTO concentration on the encapsulation efficiency each set’s films were prepared with DTO concentrations of 10mM, 20mM, and 30mM. The encapsulation efficiency remained high for each MTMR9 liposome formulation containing 3% DOTAP for each applied DTO concentrations of 10mM, 20mM, and 30mM. The encapsulation efficiencies of DTO for POPC samples were 69.7 ± 2.3%, 82.8 ± 7.1%, 79.2 ± 8.1%, while for the DOPC samples DTO encapsulation efficiencies of 74.2 ± 2.0%, 86.2 ± 3.9%, and 89.9 ± 4.2% were determined, for 10mM, 20mM, and 30mM DTO concentrations, respectively. For a given DTO concentration there was no significant difference between the encapsulation efficiency values for DOPC or POPC liposomes (P > 0.05). 3.1.

Nonpharinacological BTK phosphorylation approaches to Alzheimer’s disease As emphasized by Reichman,147 pharmacological approaches can be combined with behavioral and environmental interventions that assist patients

in maintaining the highest, possible level of function. Patients in the early stages of dementia may benefit from support groups and other constructive environments that provide information and feedback on the cognitive and behavioral symptoms. Attempts to improve cognitive function Inhibitors,research,lifescience,medical in AD patients through reality orientation, reminiscence, and memory retraining have had some limited success.148 Reality orientation was developed primarily to reduce confusion and disorientation in dementia patients in institutionalized settings. A key feature of reality orientation is Inhibitors,research,lifescience,medical to remind patients of who and where they are, provide feedback on time of day, day of week, etc, comment, on and describe what is happening at a given moment in time, and generally reinforce the patient’s awareness of their environment. Recent studies have observed improvements on the MMSE following sustained Inhibitors,research,lifescience,medical treatment, with reality orientation.149,150 However, such changes are often observed on the

orientation components of the MMSE-, and reality orientation does not appear to significantly impact behavioral functioning and, despite improvement, in cognition, improvements in IADL were not observed in several studies.150,151 There are a variety of memory training techniques that have been employed with some success in nondemented older adults, and we discuss these in detail Inhibitors,research,lifescience,medical below. These techniques are typically not effective in patients with dementia since their success relies upon utilization of many of the information-processing systems, which are no longer intact, in dementia. However, prosthetic memory aids such as diaries, memory wallets, and well-placed lists around the house and garden have been found to be helpful, particularly for early-stage patients who

can benefit from the Inhibitors,research,lifescience,medical type of mnemonic cueing such aids provide.152,153 Reminiscence therapy has also been postulated to be a potentially effective therapy for patients with dementia since studies suggest, that memories for remote events remain intact, longer than other forms of memory. Reminiscence aminophylline therapy aims to facilitate recall of past experiences with the overall goal of enhancing well-being. Few systematic studies of the effectiveness of reminiscence therapy in dementia patients exist, but the limited data available suggest that this technique may be more beneficial to interpersonal communication than cognitive processing.154-156 Indeed, many of the aforementioned techniques can also frustrate the dementia patient, by underscoring the limitations of their cognitive functioning. Behavioral therapy approaches aimed at, decreasing agitation, negative thoughts, and depression, and improving self-care have been quite successful.

As a result, management in MCI could be handled within the resources of the emergency team based on emergency physicians cooperating with other specialists, as well as nursing staffs. Finally, it was found that three victims were predicted to die due to high TRISS but one victim unexpectedly survived despite having a high TRISS due to effective resuscitation and good

cooperation from multidisciplinary health care services. Limitation By nature, research on disaster medicine is largely descriptive as MCI is virtually impossible to study via prospective randomized controlled trials and the study could not be double Inhibitors,research,lifescience,medical blinded or concealed. Regarding hospital preparedness in specific circumstances as military MCI, health care providers cannot normally access in the operation zone where WMDs were used and could not Inhibitors,research,lifescience,medical normally evacuate or transport casualties because of entrapment by the crowds resulting in delayed prehospital time from minutes to hours or even days. Implementation and suggestion Knowledge in mechanism of injury, distribution of injured

body regions together with the proven factors influencing ISS used to predict mortality, are all important keys for proper medical management and preventive measures. Implications concerning hospital organizational aspects include improving management with limited health care resources and enhancing hospital surge capacity for Inhibitors,research,lifescience,medical MCI. Implications concerning the Ministry of Defence aspects include improving effectiveness of Inhibitors,research,lifescience,medical protective equipment in future military MCI. Implications concerning the national aspects include Sotrastaurin price establishing harmonized military-civilian collaboration in MCI response network. This study is based on cases in a military hospital, and recommendations may require non- military studies in public health hospitals

to compare results. MCIs are heterogeneous Inhibitors,research,lifescience,medical by nature and their unexpectedness favors an “all-hazard” approach including radiation & nuclear wastes, bioterrorism, chemical weapons or explosion. MCI preparedness must be prompt every time. Conclusions Blast injury was the most common mechanism of injury among Thai military personnel injured in the MCI April 10, 2010. Age and injured body regions such as head & neck, chest and abdomen Thalidomide were proven factors influencing ISS. These factors should be considered for effective medical treatment and preparing protective equipment to prevent such injuries in the future. Competing interests The authors have no relevant financial interests, financial relationships, or competing interests (financial or nonfinancial) to report. Authors’ contributions NB reviewed literature, conceived & designed the study, requested & revised proposal submission throughout ethical process, managed the collected data, performed the data analysis & result interpretation, drafted & revised the manuscript. SI conceived the study, participated to the study design.

Heterologous desensitization occurs when the binding of one agonist to a receptor subtype induces the attenuation of another receptor signaling (eg, desensitization of hypothalamic 5-HT1A receptors following 5-HT2A activation, desensitization of 5-HT2A receptors by activation of 5-HT1A receptors in the same region). Homodimerization/heterodimerization Most membrane G protein-coupled receptors exist as dimers or oligomers. A complex formed by two identical receptors (eg, 5-HT2A/5-HT2A; 5-HT2C/5-HT2C receptors) is called a homodimer, whereas a complex formed by unrelated receptors is heterodimer (eg, 5-HT2A/ Glutamate

receptor 2; 5-HT2A/D2 Inhibitors,research,lifescience,medical receptors). Dimerization occurs during transport of newly formed receptors to the cell surface. The homo- or heterodimeric complexes influence the signaling and internalization of receptors. MicroRNAs MicroRNA are small noncoding RNAs mediating posttranscriptional gene regulation (mostly translational repression). Thus, it was recently demonstrated that fluoxetine infusion Inhibitors,research,lifescience,medical in the dorsal raphe

nucleus increases the level of a microRNA called miR-16 and consequently downregulates the mRNA and protein expression of the membrane serotonin transporter. Somatodendritic receptors Somatodendritic receptors are localized on the membrane of the cell bodies (soma) and dendrites Inhibitors,research,lifescience,medical of neurons, eg, the somatodendritic 5-HT1 A receptors in the dorsal raphe nucleus. Symporters A family of membrane molecules coupling the transmembrane movement of a transmitter (monoamine or amino Inhibitors,research,lifescience,medical acid) to the transport of ions (mainly Na+, K+ and Cl-). Neurotransmitter find more transporters (also called neuronal or membrane transporters) play a major role in the regulation of neurotransmission by energy-dependent reuptake of the neurotransmitters from the extracellular space. The neurotransmitter is then recycled by a vesicular transporter (eg, monoamine vesicular transporters) or degraded. Vesicular-filling synergy Inhibitors,research,lifescience,medical Vesicular-filling synergy

(or vesicular synergy) first reported in cholinergic neurons was also detected in 5HT circuitries, especially in limbic areas (hippocampus, prefrontal Resveratrol cortex). The coexpression of a vesicular glutamate transporter (VGLUT3) and a vesicular monoamine transporter (VMAT2) on the same vesicles of 5-HT terminal subpopulations represents a local synergic mechanism between glutamate and 5-HT neurotransmitters. It was demonstrated that glutamate reuptake stimulates vesicular 5-HT accumulation by VMAT2. Thus, 5-HT transmission is locally tuned by glutamate. Wiring/volume neurotransmission In wiring neurotransmission the communication between neurons operates via specialized junctional complexes including synapses (intercellular space in the synaptic cleft around 20 nm).

Also we used the medical record linkage system to further improve the quality of the data. The other limitation of our study is the generalizibility of the results. The restricted mid-western population, predominantly Caucasian, may limit the generalizability of our study results. However, the population-based nature and various steps taken for quality assessment in our study help in addressing these concerns. Also, studies from the Olmsted County have consistently shown that their findings are generalizable to the Upper Midwest population

[40], and may also provide important information regarding various diseases [16]. In addition, during Inhibitors,research,lifescience,medical the study duration, the use of NIV was not consistent on the regular hospital floors. This might slightly increase the incidence rate of NIV in ARF patients, however, it is unlikely to have affected our findings Inhibitors,research,lifescience,medical significantly. Conclusion In conclusion, in this population-based study of Olmsted County residents, we showed the incidence of NIV use

Inhibitors,research,lifescience,medical in patients with ARF was high and NIV was commonly used as the initial treatment strategy and for palliative care of ARF in critically ill patients. The development of ARDS and higher APACHE III score were associated with the failure of initial NIV treatment. The results of this study could be helpful in the future planning of noninvasive mechanical ventilation Inhibitors,research,lifescience,medical use in the community-based ICU settings. Competing Ixazomib nmr interest None of the authors have any disclosures or conflict of interest. Authors’ contributions

SW and GL contributed to the study design, conduct and manuscript writing. SW, BS, LT, MB, ILK and MK contributed in the data collection and the conduct of the study. WS and GL analyzed the data. SW, BS, LT, MB, ILK, MK, and GL helped with the preparation and revision of the manuscript. GL supervised and was involved as senior author in all critical parts of the study. All authors read and approved the final manuscript. Pre-publication history The pre-publication history for this paper can be accessed Inhibitors,research,lifescience,medical here: http://www.biomedcentral.com/1471-227X/13/6/prepub Acknowledgments We wish to thank all members of the METRIC group for constant and constructive feedback. Location of study The study was performed at Mayo Clinic, Rochester, MN, USA.
Echis carinatus (Saw scaled viper SSV) is a venomous snake found in the parts of Middle East and Central because Asia [1]. In Sri Lanka SSV is found in the dry coastal plains of northern, north-western and eastern provinces [2,3]. SSV envenoming is characterized by local swelling and coagulopathy. Various bleeding manifestations are commonly seen with SSV envenoming. Common bleeding manifestations include gingival bleeding, haematuria, epistaxis, haemoptysis and haematemesis. In a case series involving 48 SSV bite victims, 71% had coagulopathy as evidence by 20 min WBCT.