{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:20:25Z","timestamp":1790792425883,"version":"4.1.0"},"reference-count":63,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p><jats:italic>Bothrops<\/jats:italic> venom acts almost immediately at the bite site and causes tissue damage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the feasibility and explore the safety and efficacy of low-level laser therapy (LLLT) in reducing the local manifestations of <jats:italic>B atrox<\/jats:italic> envenomations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This was a double-blind randomized clinical trial conducted at Funda\u00e7\u00e3o de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, Brazil. A total of 60 adult participants were included from November 2020 to March 2022, with 30 in each group. Baseline characteristics on admission were similarly distributed between groups. Data analysis was performed from August to December 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>The intervention group received LLLT combined with regular antivenom treatment. The laser used was a gallium arsenide laser with 4 infrared laser emitters and 4 red laser emitters, 4 J\/cm<jats:sup>2<\/jats:sup> for 40 seconds at each application point.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Feasibility was assessed by eligibility, recruitment, and retention rates; protocol fidelity; and patients\u2019 acceptability. The primary efficacy outcome of this study was myolysis estimated by the value of creatine kinase (U\/L) on the third day of follow-up. Secondary efficacy outcomes were (1) pain intensity, (2) circumference measurement ratio, (3) extent of edema, (4) difference between the bite site temperature and that of the contralateral limb, (5) need for the use of analgesics, (6) frequency of secondary infections, and (7) necrosis. These outcomes were measured 48 hours after admission. Disability assessment was carried out from 4 to 6 months after patients\u2019 discharge. <jats:italic>P<\/jats:italic> values for outcomes were adjusted with Bonferroni correction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 60 patients (mean [SD] age, 43.2 [15.3] years; 8 female individuals [13%] and 52 male individuals [87%]) were included. The study was feasible, and patient retention and acceptability were high. Creatine kinase was significantly lower in the LLLT group (mean [SD], 163.7 [160.0] U\/L) 48 hours after admission in relation to the comparator (412.4 [441.3] U\/L) (<jats:italic>P<\/jats:italic>\u2009=\u2009.03). Mean (SD) pain intensity (2.9 [2.7] vs 5.0 [2.4]; <jats:italic>P<\/jats:italic>\u2009=\u2009.004), circumference measurement ratio (6.6% [6.6%] vs 17.1% [11.6%]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), and edema extent (25.9 [15.0] vs 45.9 [24.7] cm; <jats:italic>P<\/jats:italic>\u2009=\u2009.002) were significantly lower in the LLLT group in relation to the comparator. No difference was observed between the groups regarding the mean difference between the bite site temperature and the contralateral limb. Secondary infections, necrosis, disability outcomes, and the frequency of need for analgesics were similar in both groups. No adverse event was observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The data from this randomized clinical trial suggest that the use of LLLT was feasible and safe in a hospital setting and effective in reducing muscle damage and the local inflammatory process caused by <jats:italic>B atrox<\/jats:italic> envenomations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>Brazilian Registry of Clinical Trials Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/ensaiosclinicos.gov.br\/rg\/RBR-4qw4vf\">RBR-4qw4vf<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2023.6538","type":"journal-article","created":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T16:00:58Z","timestamp":1701705658000},"page":"70","source":"Crossref","is-referenced-by-count":16,"title":["Photobiomodulation Therapy to Treat Snakebites Caused by <i>Bothrops atrox<\/i>"],"prefix":"10.1001","volume":"184","author":[{"given":"\u00c9rica da Silva","family":"Carvalho","sequence":"first","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"},{"name":"Department of Teaching and Research, Funda\u00e7\u00e3o de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Renata do Nascimento","family":"Souza","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"},{"name":"Department of Teaching and Research, Funda\u00e7\u00e3o de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dessana Francis Chehuan","family":"Melo","sequence":"additional","affiliation":[{"name":"Department of Teaching and Research, Funda\u00e7\u00e3o de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil"},{"name":"School of Medicine, Universidade Federal do Amazonas, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Altair Seabra","family":"de Farias","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"},{"name":"Department of Teaching and Research, Funda\u00e7\u00e3o de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna Barbosa de Oliveira","family":"Macedo","sequence":"additional","affiliation":[{"name":"Department of Teaching and Research, Funda\u00e7\u00e3o de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Aur\u00e9lio","family":"Sartim","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"},{"name":"Department of Teaching and Research, Funda\u00e7\u00e3o de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil"},{"name":"Universidade Nilton Lins, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariela Costa","family":"Caggy","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz de Alc\u00e2ntara","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela Salini","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helo\u00edsa Nunes","family":"Reis","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe Queiroz","family":"Ara\u00fajo","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iran Mendon\u00e7a","family":"da Silva","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"},{"name":"Department of Teaching and Research, Funda\u00e7\u00e3o de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Sachett","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"},{"name":"Department of Teaching and Research, Funda\u00e7\u00e3o de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanderson de Souza","family":"Sampaio","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"},{"name":"Department of Teaching and Research, Funda\u00e7\u00e3o de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ant\u00f4nio Alcirley da Silva","family":"Balieiro","sequence":"additional","affiliation":[{"name":"Instituto Le\u00f4nidas e Maria Deane - ILMD\/Fiocruz, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella Regina","family":"Zamuner","sequence":"additional","affiliation":[{"name":"Universidade Nove de Julho, Uninove, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Ricardo Nickenig","family":"Vissoci","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Duke Global Health Institute (DGHI), Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lioney Nobre","family":"Cabral","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wuelton Marcelo","family":"Monteiro","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"},{"name":"Department of Teaching and Research, Funda\u00e7\u00e3o de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline de Almeida Gon\u00e7alves","family":"Sachett","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil"},{"name":"Department of Teaching and Research, Funda\u00e7\u00e3o de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil"},{"name":"Department of Teaching and Research, Funda\u00e7\u00e3o Alfredo da Matta, Manaus, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"key":"ioi230080r1","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxcx.2020.100043","article-title":"Snakebite envenoming from an Ecohealth perspective.","volume":"7","author":"Guti\u00e9rrez","year":"2020","journal-title":"Toxicon X"},{"issue":"12","key":"ioi230080r2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0000569","article-title":"Snake envenoming: a disease of poverty.","volume":"3","author":"Harrison","year":"2009","journal-title":"PLoS Negl Trop Dis"},{"issue":"8","key":"ioi230080r3","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.1500249","article-title":"Snakebites are associated with poverty, weather fluctuations, and El Ni\u00f1o.","volume":"1","author":"Chaves","year":"2015","journal-title":"Sci Adv"},{"key":"ioi230080r4","doi-asserted-by":"publisher","first-page":"17063","DOI":"10.1038\/nrdp.2017.63","article-title":"Snakebite envenoming.","volume":"3","author":"Guti\u00e9rrez","year":"2017","journal-title":"Nat Rev Dis Primers"},{"issue":"6","key":"ioi230080r5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0005662","article-title":"Incidence and mortality due to snakebite in the Americas.","volume":"11","author":"Chippaux","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"ioi230080r6","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.toxicon.2019.10.238","article-title":"Ethno-knowledge and attitudes regarding snakebites in the Alto Juru\u00e1 region, Western Brazilian Amazonia.","volume":"171","author":"da Silva","year":"2019","journal-title":"Toxicon"},{"issue":"7","key":"ioi230080r7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0005647","article-title":"The socio-economic burden of snakebite in Sri Lanka.","volume":"11","author":"Kasturiratne","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"issue":"7","key":"ioi230080r8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0132237","article-title":"Older age and time to medical assistance are associated with severity and mortality of snakebites in the Brazilian Amazon: a case-control study.","volume":"10","author":"Feitosa","year":"2015","journal-title":"PLoS One"},{"issue":"5","key":"ioi230080r9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003701","article-title":"Snakebites and scorpion stings in the Brazilian Amazon: identifying research priorities for a largely neglected problem.","volume":"9","author":"Hui Wen","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"ioi230080r10","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxcx.2020.100037","article-title":"Bothrops atrox, the most important snake involved in human envenomings in the amazon: how venomics contributes to the knowledge of snake biology and clinical toxinology.","volume":"6","author":"Monteiro","year":"2020","journal-title":"Toxicon X"},{"issue":"2","key":"ioi230080r11","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/j.jprot.2009.01.001","article-title":"Bothrops insularis venomics: a proteomic analysis supported by transcriptomic-generated sequence data.","volume":"72","author":"Valente","year":"2009","journal-title":"J Proteomics"},{"key":"ioi230080r12","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.jprot.2017.03.003","article-title":"Functional proteomic analyses of Bothrops atrox venom reveals phenotypes associated with habitat variation in the Amazon.","volume":"159","author":"Sousa","year":"2017","journal-title":"J Proteomics"},{"issue":"5","key":"ioi230080r13","doi-asserted-by":"publisher","first-page":"177","DOI":"10.3390\/toxins10050177","article-title":"Proteopeptidomic, functional and immunoreactivity characterization of Bothrops moojeni snake venom: influence of snake gender on venom composition.","volume":"10","author":"Amorim","year":"2018","journal-title":"Toxins (Basel)"},{"issue":"2","key":"ioi230080r14","doi-asserted-by":"publisher","first-page":"96","DOI":"10.3390\/toxins12020096","article-title":"Inflammatory reaction induced by two metalloproteinases isolated from Bothrops atrox venom and by fragments generated from the hydrolysis of basement membrane components.","volume":"12","author":"Almeida","year":"2020","journal-title":"Toxins (Basel)"},{"issue":"11","key":"ioi230080r15","doi-asserted-by":"publisher","first-page":"800","DOI":"10.3390\/toxins13110800","article-title":"Observation of Bothrops atrox snake envenoming blister formation from five patients: pathophysiological insights.","volume":"13","author":"Gimenes","year":"2021","journal-title":"Toxins (Basel)"},{"issue":"3","key":"ioi230080r16","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.wem.2020.03.001","article-title":"Bothrops atrox snakebite: how a bad decision may lead to a chronic disability: a case report.","volume":"31","author":"Sachett","year":"2020","journal-title":"Wilderness Environ Med"},{"issue":"4","key":"ioi230080r17","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1001\/jamasurg.2018.5069","article-title":"Does this patient have a severe snake envenomation?: the Rational Clinical Examination systematic review.","volume":"154","author":"Gerardo","year":"2019","journal-title":"JAMA Surg"},{"issue":"4","key":"ioi230080r19","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1016\/j.toxicon.2009.12.014","article-title":"Antigenic cross-reactivity and immunogenicity of Bothrops venoms from snakes of the Amazon region.","volume":"55","author":"Furtado","year":"2010","journal-title":"Toxicon"},{"issue":"2","key":"ioi230080r20","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.toxicon.2007.03.010","article-title":"Evaluation of three Brazilian antivenom ability to antagonize myonecrosis and hemorrhage induced by Bothrops snake venoms in a mouse model.","volume":"50","author":"da Silva","year":"2007","journal-title":"Toxicon"},{"issue":"6","key":"ioi230080r21","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1016\/j.toxicon.2010.07.001","article-title":"Preclinical assessment of the neutralizing capacity of antivenoms produced in six Latin American countries against medically-relevant Bothrops snake venoms.","volume":"56","author":"Segura","year":"2010","journal-title":"Toxicon"},{"issue":"152","key":"ioi230080r22","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.toxicon.2018.07.006","article-title":"Photobiomodulation therapy on Bothrops snake venom-induced local pathological effects: a systematic review.","volume":"152","author":"Silva","year":"2018","journal-title":"Toxicon"},{"issue":"7","key":"ioi230080r23","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1016\/j.toxicon.2008.02.007","article-title":"Effect of low-level laser therapy in the inflammatory response induced by Bothrops jararacussu snake venom.","volume":"51","author":"Barbosa","year":"2008","journal-title":"Toxicon"},{"issue":"5","key":"ioi230080r24","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1002\/lsm.v33:5","article-title":"Effects of the Ga-As laser irradiation on myonecrosis caused by Bothrops moojeni snake venom.","volume":"33","author":"Dourado","year":"2003","journal-title":"Lasers Surg Med"},{"issue":"4","key":"ioi230080r26","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1007\/s42600-021-00184-x","article-title":"The use of ozone therapy and photobiomodulation therapy to treat local effects of Bothrops jararacussu snake venom.","volume":"37","author":"Fernandes","year":"2021","journal-title":"Res Biomed Eng"},{"issue":"4","key":"ioi230080r27","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1089\/pho.2008.2296","article-title":"Effect of low-level laser therapy in the myonecrosis induced by Bothrops jararacussu snake venom.","volume":"27","author":"Barbosa","year":"2009","journal-title":"Photomed Laser Surg"},{"issue":"3","key":"ioi230080r28","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1590\/S1678-91992010000300014","article-title":"Low-level laser therapy decreases local effects induced by myotoxins isolated from Bothrops jararacussu snake venom.","volume":"16","author":"Barbosa","year":"2010","journal-title":"J Venom Anim Toxins Incl Trop Dis"},{"issue":"April","key":"ioi230080r29","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.toxicon.2021.05.009","article-title":"Photobiomodulation induces murine macrophages polarization toward M2 phenotype.","volume":"198","author":"Reis","year":"2021","journal-title":"Toxicon"},{"key":"ioi230080r30","doi-asserted-by":"publisher","DOI":"10.1016\/j.cbi.2020.109347","article-title":"Effect of light emitting diode photobiomodulation on murine macrophage function after Bothrops envenomation.","volume":"333","author":"Reis","year":"2021","journal-title":"Chem Biol Interact"},{"issue":"10","key":"ioi230080r31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0008727","article-title":"Interventions for the management of snakebite envenoming: an overview of systematic reviews.","volume":"14","author":"Bhaumik","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"ioi230080r33","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1177\/0962280215588241","article-title":"Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable.","volume":"25","author":"Whitehead","year":"2016","journal-title":"Stat Methods Med Res"},{"issue":"11","key":"ioi230080r34","doi-asserted-by":"publisher","first-page":"668","DOI":"10.3390\/toxins12110668","article-title":"Current knowledge on snake dry bites.","volume":"12","author":"Pucca","year":"2020","journal-title":"Toxins (Basel)"},{"issue":"4","key":"ioi230080r35","first-page":"221","article-title":"Low intensity laser: principles and generalities\u2014part 1.","volume":"2","author":"Ortiz","year":"2001","journal-title":"Fisioter Bras"},{"issue":"3","key":"ioi230080r36","doi-asserted-by":"publisher","first-page":"R33","DOI":"10.1088\/0967-3334\/33\/3\/R33","article-title":"Infrared thermal imaging in medicine.","volume":"33","author":"Ring","year":"2012","journal-title":"Physiol Meas"},{"issue":"2","key":"ioi230080r37","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1590\/0037-8682-0390-2016","article-title":"Infrared thermography to diagnose and manage venomous animal bites and stings.","volume":"50","author":"Medeiros","year":"2017","journal-title":"Rev Soc Bras Med Trop"},{"issue":"7889","key":"ioi230080r38","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1016\/S0140-6736(74)90884-8","article-title":"Measurement of pain.","volume":"2","author":"Huskisson","year":"1974","journal-title":"Lancet"},{"issue":"1","key":"ioi230080r40","doi-asserted-by":"publisher","first-page":"6094","DOI":"10.1038\/s41467-020-19981-6","article-title":"A therapeutic combination of two small molecule toxin inhibitors provides broad preclinical efficacy against viper snakebite.","volume":"11","author":"Albulescu","year":"2020","journal-title":"Nat Commun"},{"issue":"11","key":"ioi230080r41","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1089\/pho.2016.4149","article-title":"Beneficial effects of applying low-level laser therapy to surgical wounds after bariatric surgery.","volume":"34","author":"Ojea","year":"2016","journal-title":"Photomed Laser Surg"},{"key":"ioi230080r42","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.toxicon.2021.08.016","article-title":"Pain modulated by Bothrops snake venoms: mechanisms of nociceptive signaling and therapeutic perspectives.","volume":"201","author":"Cavalcante","year":"2021","journal-title":"Toxicon"},{"issue":"7","key":"ioi230080r43","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0005745","article-title":"Poor efficacy of preemptive amoxicillin clavulanate for preventing secondary infection from Bothrops snakebites in the Brazilian Amazon: a randomized controlled clinical trial.","volume":"11","author":"Sachett","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"ioi230080r44","first-page":"97","article-title":"Low-level laser therapy reduces edema, leukocyte influx and hyperalgesia induced by Bothrops jararacussu snake venom.","volume":"52","author":"Souza","year":"2011","journal-title":"Medical Science and Technology"},{"issue":"10","key":"ioi230080r45","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0004998","article-title":"Analgesic effect of photobiomodulation on Bothrops moojeni venom-induced hyperalgesia: a mechanism dependent on neuronal inhibition, cytokines and kinin receptors modulation.","volume":"10","author":"Nadur-Andrade","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"ioi230080r46","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1089\/pho.2006.24.33","article-title":"Low-level laser therapy induces dose-dependent reduction of TNFa levels in acute inflammation.","volume":"24","author":"Aimbire","year":"2006","journal-title":"Photomed Laser Surg"},{"issue":"3-4","key":"ioi230080r47","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s10103-005-0350-1","article-title":"Anti-inflammatory effect of linear polarized infrared irradiation on interleukin-1\u00df-induced chemokine production in MH7A rheumatoid synovial cells.","volume":"20","author":"Shibata","year":"2005","journal-title":"Lasers Med Sci"},{"issue":"9","key":"ioi230080r48","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1002\/lsm.v49.9","article-title":"Antinociceptive effects of low-level laser therapy at 3 and 8?j\/cm2 in a rat model of postoperative pain: possible role of endogenous opioids.","volume":"49","author":"Pereira","year":"2017","journal-title":"Lasers Surg Med"},{"issue":"5","key":"ioi230080r49","doi-asserted-by":"publisher","first-page":"e4","DOI":"10.1016\/j.tripleo.2006.02.024","article-title":"Postoperative analgesia after lower third molar surgery: contribution of the use of long-acting local anesthetics, low-power laser, and diclofenac.","volume":"102","author":"Markovic","year":"2006","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"issue":"1","key":"ioi230080r50","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1007\/s10103-019-02837-x","article-title":"A randomized clinical trial comparing the efficacy of low-level laser therapy (LLLT) and laser acupuncture therapy (LAT) in patients with temporomandibular disorders.","volume":"35","author":"Madani","year":"2020","journal-title":"Lasers Med Sci"},{"issue":"1","key":"ioi230080r51","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.intimp.2015.06.001","article-title":"Inflammatory mediators involved in the paw edema and hyperalgesia induced by Batroxase, a metalloproteinase isolated from Bothrops atrox snake venom.","volume":"28","author":"De Toni","year":"2015","journal-title":"Int Immunopharmacol"},{"issue":"1","key":"ioi230080r52","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1590\/S0104-42302001000100026","article-title":"Snake bites.","volume":"47","author":"Pinho","year":"2001","journal-title":"Rev Assoc Med Bras (1992)"},{"issue":"9","key":"ioi230080r53","doi-asserted-by":"publisher","first-page":"66814","DOI":"10.34117\/bjd","article-title":"Photobiomodulation in the skin healing process\u2014literature review.","volume":"6","author":"Gomes","year":"2020","journal-title":"Brazilian J Dev."},{"issue":"2","key":"ioi230080r54","first-page":"29","article-title":"Histological evaluation of the effects of LLLT on the epithelial, connective and osseous tissue healing: experimental study in rats.","volume":"4","author":"Marcos","year":"2007","journal-title":"Rev Sul-Brasileira Odontol"},{"issue":"4","key":"ioi230080r55","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1590\/S1413-35552009005000040","article-title":"Effects of low-level laser therapy on epidermal oxidative response induced by wound healing.","volume":"13","author":"Silveira","year":"2009","journal-title":"Rev Bras Fisioter"},{"issue":"1","key":"ioi230080r56","first-page":"70","article-title":"Mediators of the systemic effects of inflammation and photobiomodulatory therapies: a literature review.","volume":"11","author":"Chamusca","year":"2012","journal-title":"Rev Ci\u00eanc M\u00e9d Biol"},{"issue":"2","key":"ioi230080r57","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1111\/php.2011.87.issue-2","article-title":"Low-level laser therapy promotes vascular endothelial growth factor receptor-1 expression in endothelial and nonendothelial cells of mice gastrocnemius exposed to snake venom.","volume":"87","author":"Dourado","year":"2011","journal-title":"Photochem Photobiol"},{"issue":"8","key":"ioi230080r58","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1016\/j.toxicon.2003.11.005","article-title":"Skeletal muscle degeneration induced by venom phospholipases A2: insights into the mechanisms of local and systemic myotoxicity.","volume":"42","author":"Guti\u00e9rrez","year":"2003","journal-title":"Toxicon"},{"issue":"8","key":"ioi230080r59","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1016\/j.toxicon.2003.11.027","article-title":"Mapping structural determinants of biological activities in snake venom phospholipases A2 by sequence analysis and site directed mutagenesis.","volume":"42","author":"Chioato","year":"2003","journal-title":"Toxicon"},{"issue":"6","key":"ioi230080r60","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1016\/S0041-0101(03)00007-2","article-title":"Hyperalgesia induced by Asp49 and Lys49 phospholipases A2 from Bothrops asper snake venom: pharmacological mediation and molecular determinants.","volume":"41","author":"Chacur","year":"2003","journal-title":"Toxicon"},{"issue":"9-10","key":"ioi230080r61","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1016\/S0300-9084(00)01163-9","article-title":"Snake venom metalloproteinases: their role in the pathogenesis of local tissue damage.","volume":"82","author":"Guti\u00e9rrez","year":"2000","journal-title":"Biochimie"},{"issue":"6","key":"ioi230080r62","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1007\/s10103-017-2252-4","article-title":"Effects of photobiomodulation therapy on Bothrops moojeni snake-envenomed gastrocnemius of mice using enzymatic biomarkers.","volume":"32","author":"Dourado","year":"2017","journal-title":"Lasers Med Sci"},{"key":"ioi230080r63","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.toxicon.2018.07.029","article-title":"Light emitting diode (LED) therapy reduces local pathological changes induced by Bothrops asper snake venom.","volume":"152","author":"Campos","year":"2018","journal-title":"Toxicon"},{"key":"ioi230080r25","volume-title":"Laser de Baixa Intensidade: Aplica\u00e7\u00f5es Terap\u00eauticas Em Odontologia","author":"Genovese","year":"2000"},{"key":"ioi230080r32","volume-title":"Guide to the Snakes of the Manaus Region - Central Amazonia","author":"Fraga","year":"2013"},{"key":"ioi230080r39","volume-title":"Avalia\u00e7\u00e3o de Sa\u00fade e Defici\u00eancia: Manual do WHO Disability Assessment Schedule (WHODAS 2.0)","author":"Organiza\u00e7\u00e3o Mundial de Sa\u00fade","year":"2015"},{"key":"ioi230080r18","unstructured":"Minist\u00e9rio da Sa\u00fade. Guia de vigil\u00e2ncia em sa\u00fade. 5th ed. Accessed October 24, 2023. https:\/\/bvsms.saude.gov.br\/bvs\/publicacoes\/guia_vigilancia_saude_5ed_rev_atual.pdf"}],"container-title":["JAMA Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/articlepdf\/2812544\/jamainternal_carvalho_2023_oi_230080_1705083746.67464.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,16]],"date-time":"2024-01-16T16:03:44Z","timestamp":1705421024000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2812544"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2024,1,1]]},"references-count":63,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamainternmed.2023.6538","relation":{},"ISSN":["2168-6106"],"issn-type":[{"value":"2168-6106","type":"print"}],"subject":[],"published":{"date-parts":[[2024,1,1]]}}}