Factors associated with severe envenomation of snakebite cases at emergency department, Hospital Sultan Abdul Halim, Kedah, Malaysia.

INTRODUCTION: Snakebite envenomation is a medical emergency and cases continue to be encountered in Malaysian hospitals. This study aims to determine the prevalence of snakebite presentations and the associated factors with severe envenomation of snakebite in Sungai Petani, Kedah, Malaysia. MATERIALS AND METHODS: This was a retrospective, crosssectional study involving snakebite patients presented at the Emergency Department (ED), Hospital Sultan Abdul Halim (HSAH), Kedah from 1 July 2015 to 30 June 2019. The cases were extracted from the computerized system and the case records of patients were retrieved from the Medical Record Unit. Patients that met the study criteria were included and their sociodemographic features, clinical presentations including use of anti-venom were collected. Logistic regression analysis was performed to determine the factors associated with severe envenomation. RESULTS: A total of 220 snakebite cases with the mean age of patients was 39.66 (SD±21.79) years old. Majority of them were Malay and males. 41.4% of snakebite cases occurred in late evenings and the mean time-lapsed to arrive at HSAH was 108.6 minutes. 81.4% of snakebite cases occurred while engaging in outdoor activities and 43.6% of the snakebite cases involved work-related incidents. 58.2% of the patients were bitten in the lower limb. 78.6% of patients were bitten by the identified snake species, predominantly from Viperidae family. The prevalence of severe envenomation was 50.9%. Malay ethnicity (adj. OR =2.549, 95% CI =1.277,5.089), bite to the upper limb (adj. OR =2.125, 95% CI =1.192, 3.790), and bite by snakes from Viperidae family (adj. OR =3.017, 95% CI =1.613, 5.642) were found to have significant associations with severe envenomation of snakebite. CONCLUSION: The prevalence of severe envenomation was more than 50% of snakebite cases. Malay ethnicity, upper limb snake bites, and snakebite from a Viperidae family had a higher chance of severe envenomation.

Antimonene nanosheets with enhanced electrochemical performance for energy storage applications.

Antimonene is an exfoliated 2D nanomaterial obtained from bulk antimony. It is a novel class of 2D material for energy storage applications. In the present work, antimonene was synthesized using a high-energy ball milling-sonochemical method. The structural, morphological, thermal, and electrochemical properties of antimonene were comparatively analyzed against bulk antimony. X-ray diffractometry (XRD) analysis confirms the crystal structure and 2D structure of antimonene, as a peak shift was observed. The Raman spectra show the peak shift for the Eg and A1g modes of vibration of antimony, which confirms the formation of antimonene. Scanning electron microscopy (SEM) and high-resolution transmission electron microscopy (HRTEM) images depict the exfoliation of antimonene from bulk antimony. Thermal analysis unveiled the thermal stability of antimonene up to 400 °C with only 3% weight loss. X-ray photoelectron spectroscopy (XPS) analysis reveals the formation of antimonene, which is free from contamination. The electrochemical properties of antimony and antimonene were investigated using cyclic voltammetry (CV) and chronopotentiometric (CP) analysis, using 2 M KOH as an electrolyte. Antimonene exhibited a relatively high specific capacitance of 597 F g-1 compared to ball-milled antimony (101 F g-1) at a scan rate of 10 mV s-1. Moreover, electrochemical impedance spectroscopy (EIS) analysis revealed that antimonene has a relatively low equivalence series resistance (RESR) and low charge transfer resistance (RCT) compared to bulk antimony, which favors high electrochemical performance. The cyclic stability of antimonene was studied for 3000 cycles, and the results show high cyclic stability. The electrochemical results demonstrated that antimonene is a promising material for energy storage applications.