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Hsu JY, Chiang SO, Yang CC, Mao YC. A Nationwide Study on the Risks of Complications and Healthcare Costs of Snakebite Envenomation in Taiwan. Am J Trop Med Hyg 2024; 111:205-215. [PMID: 38714189 PMCID: PMC11229656 DOI: 10.4269/ajtmh.24-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/04/2024] [Indexed: 05/09/2024] Open
Abstract
In Taiwan, six medically important venomous snakes, Trimeresurus stejnegeri stejnegeri, Protobothrops mucrosquamatus, Deinagkistrodon acutus, Daboia siamensis, Naja atra, and Bungarus multicinctus, are found. However, comprehensive research on the complications and associated healthcare costs of snakebite envenomation (SBE) is lacking. We retrospectively analyzed pertinent information from the Taiwan National Health Insurance Research Database dated January 2002 to December 2014. We investigated the risk factors for complications and their impact on healthcare costs. Among the 12,542 patients with SBE, those from N. atra or B. multicinctus were more likely to experience wound infections and neurological complications than were those from T. s. stejnegeri or P. mucrosquamatus. In addition, being female, being elderly, and having a Charlson Comorbidity Index equal to or greater than 3 points were associated with an increased likelihood of wound infections and psychological complications. The annual national economic burden averaged US$1,083,624, with an average healthcare cost of US$1,129 per SBE. Snakebite envenomations from N. atra or B. multicinctus, as well as various complications, resulted in significantly higher costs. It is crucial to comprehend the risk factors for complications and their role in increasing expenses to provide insight for tailored healthcare interventions, mitigate complications, and reduce the economic burdens associated with SBEs.
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Affiliation(s)
- Jen-Yu Hsu
- Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shu-O Chiang
- ESTAT Statistical Consulting Co., Ltd, Taipei, Taiwan
| | - Chen-Chang Yang
- Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yan-Chiao Mao
- PhD Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Renault A, Ng VERF, Goh WC, Hamid MNHA, Osman AMZ, Safferi RS, Mohamed Ismail Z, Ismail AK. Frequency, geographical distribution, clinical characteristics, antivenom utilisation and outcomes of King Cobra (Ophiophagus hannah) bites in Malaysia. PLoS Negl Trop Dis 2024; 18:e0012359. [PMID: 39052675 DOI: 10.1371/journal.pntd.0012359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 08/06/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
Snakebite envenomation remains an important, yet a neglected public health issue in most tropical and subtropical countries. Underdeveloped medical infrastructure, suboptimal medical services, poor documentation and failure to make snake-related injury a mandatory notifiable disease are important contributing factors. The King Cobra (Ophiophagus hannah) is a medically significant species encountered in Malaysia however, there have been few publications from the clinical perspective. The objectives of this study were to determine the frequency of King Cobra related injuries, geographical distribution, clinical presentation, type and frequency of antivenom utilization and the management outcome. This is a cross-sectional study of confirmed King Cobra related injuries consulted to Remote Envenomation Consultation Services (RECS) from 2015 to 2020. Data were extracted from the RECS database and descriptively analyzed. A total of 32 cases of King Cobra bite were identified. Most cases were from Peninsular Malaysia with the most frequent from the state of Pahang (n = 9, 28.1%). Most patients got bitten while attempting to catch or play with the snake (68.8%). Signs and symptoms of envenomation were documented in 24 (75.0%) cases and the most frequent systemic manifestation was ptosis (n = 13, 40.6%). Tracheal intubation and ventilatory support were required in 13 (40.6%) patients. Antivenom was administered to 22 (68.8%) patients with most (25.0%) receiving 10 vials (1 dose). The commonest antivenom used was monospecific King Cobra antivenom (50.0%) from Thai Red Cross. There was one death documented due to complications from necrotizing fasciitis and septicemia. Public awareness of the dangers and proper handling of King Cobras needs to be emphasised. Timely administration of the appropriate antivenom is the definitive treatment and leads to favorable outcomes.
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Affiliation(s)
- Asyhok Renault
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Vera Effa Rezar Frederic Ng
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Wan Chee Goh
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Ruth Sabrina Safferi
- Emergency and Trauma Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | | | - Ahmad Khaldun Ismail
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
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3
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Bartlett KE, Hall SR, Rasmussen SA, Crittenden E, Dawson CA, Albulescu LO, Laprade W, Harrison RA, Saviola AJ, Modahl CM, Jenkins TP, Wilkinson MC, Gutiérrez JM, Casewell NR. Dermonecrosis caused by a spitting cobra snakebite results from toxin potentiation and is prevented by the repurposed drug varespladib. Proc Natl Acad Sci U S A 2024; 121:e2315597121. [PMID: 38687786 PMCID: PMC11087757 DOI: 10.1073/pnas.2315597121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/26/2024] [Indexed: 05/02/2024] Open
Abstract
Snakebite envenoming is a neglected tropical disease that causes substantial mortality and morbidity globally. The venom of African spitting cobras often causes permanent injury via tissue-destructive dermonecrosis at the bite site, which is ineffectively treated by current antivenoms. To address this therapeutic gap, we identified the etiological venom toxins in Naja nigricollis venom responsible for causing local dermonecrosis. While cytotoxic three-finger toxins were primarily responsible for causing spitting cobra cytotoxicity in cultured keratinocytes, their potentiation by phospholipases A2 toxins was essential to cause dermonecrosis in vivo. This evidence of probable toxin synergism suggests that a single toxin-family inhibiting drug could prevent local envenoming. We show that local injection with the repurposed phospholipase A2-inhibiting drug varespladib significantly prevents local tissue damage caused by several spitting cobra venoms in murine models of envenoming. Our findings therefore provide a therapeutic strategy that may effectively prevent life-changing morbidity caused by snakebite in rural Africa.
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Affiliation(s)
- Keirah E. Bartlett
- Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
| | - Steven R. Hall
- Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
- Centre for Drugs & Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
| | - Sean A. Rasmussen
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NSB3H 1V8, Canada
| | - Edouard Crittenden
- Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
| | - Charlotte A. Dawson
- Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
| | - Laura-Oana Albulescu
- Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
- Centre for Drugs & Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
| | - William Laprade
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens LyngbyDK-2800, Denmark
| | - Robert A. Harrison
- Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
- Centre for Drugs & Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
| | - Anthony J. Saviola
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, CO80045
| | - Cassandra M. Modahl
- Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
| | - Timothy P. Jenkins
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens LyngbyDK-2800, Denmark
| | - Mark C. Wilkinson
- Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José11501–2060, Costa Rica
| | - Nicholas R. Casewell
- Centre for Snakebite Research & Interventions, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
- Centre for Drugs & Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, LiverpoolL3 5QA, United Kingdom
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4
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Talukdar A, Doley R. Identification of poorly immunodepleted phospholipase A 2 (PLA 2) proteins of Bungarus fasciatus venom from Assam, India and evaluation of Indian polyvalent antivenom using third-generation antivenomics. Toxicon 2024; 239:107617. [PMID: 38219916 DOI: 10.1016/j.toxicon.2024.107617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/16/2024]
Abstract
Bungarus fasciatus also referred to as the Banded krait is a snake which possesses venom and belongs to the Elapidae family. It is widely distributed across the Indian subcontinent and South East Asian countries and is responsible for numerous snakebites in the population. B. fasciatus possesses a neurotoxic venom and envenomation by the snake results in significant morbidity and occasional morbidity in the victim if not treated appropriately. In this study, the efficacy of Indian polyvalent antivenom (Premium Serums polyvalent antivenom) was evaluated against the venom of B. fasciatus from Guwahati, Assam (India) employing the Third-generation antivenomics technique followed by identification of venom proteins from three poorly immunodepleted peaks (P5, P6 and P7) using LC-MS/MS analysis. Seven proteins were identified from the three peaks and all these venom proteins belonged to the phospholipase A2 (PLA2) superfamily. The identified PLA2 proteins were corroborated by the in vitro enzymatic activities (PLA2 and Anticoagulant activity) exhibited by the three peaks and previous reports of pathological manifestation in the envenomated victims. Neutralization of enzymatic activities by Premium Serums polyvalent antivenom was also assessed in vitro for crude venom, P5, P6 and P7 which revealed moderate to poor inhibition. Inclusion of venom proteins/peptides, which are non-immunodepleted or poorly immunodepleted, into the immunization mixture of venom used for antivenom production may help in enhancing the efficacy of the polyvalent antivenom.
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Affiliation(s)
- Amit Talukdar
- Molecular Toxinology Laboratory, Department of Molecular Biology and Biotechnology, Tezpur University, Assam, 784028, India
| | - Robin Doley
- Molecular Toxinology Laboratory, Department of Molecular Biology and Biotechnology, Tezpur University, Assam, 784028, India.
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Pandit K, Rawal A, Maskey HMS, Nepal G. Neurological and neuro-ophthalmological manifestations of snake bite: a systematic review. Ann Med Surg (Lond) 2024; 86:392-400. [PMID: 38222724 PMCID: PMC10783398 DOI: 10.1097/ms9.0000000000001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024] Open
Abstract
Objective Snakebites, a major health concern in developing countries, affect rural farming communities. Venom, primarily neurotoxin, injected during a snake bite disrupts the nervous system, causing symptoms like muscle weakness, paralysis, altered sensation, and coordination issues. This review focuses on evaluating neurological and neuro-ophthalmological manifestations associated with snakebites. Methods A database search was conducted in EMBASE and PubMed for studies published from 2000 to 2023. The investigation centered on examining neurological and neuro-ophthalmological symptoms and signs, treatment approaches, treatment outcomes, and long-term complications of snake bites. Results Neurological and neuro-ophthalmological symptoms were common in both neurotoxic and hemotoxic snake bites, especially in neurotoxic cases. Ptosis was a prevalent manifestation across various snake bites, along with respiratory paralysis, limb weakness, dysphasia, and visual disturbances in some instances. However, most patients improved without residual neurological symptoms after treatment. Conclusions Understanding patterns of neurological manifestations contributes valuable insights for the comprehensive management of snakebite.
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Affiliation(s)
- Kamal Pandit
- Department of Ophthalmology, Maharjgunj Medical Campus, Tribhuvan University, Institute of Medicine, Maharajgunj, Kathmandu
| | - Aastha Rawal
- Department of Pharmacy, Manmohan Memorial Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Himang Man Singh Maskey
- Department of Ophthalmology, Maharjgunj Medical Campus, Tribhuvan University, Institute of Medicine, Maharajgunj, Kathmandu
| | - Gaurav Nepal
- Department of Internal Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Hall SR, Rasmussen SA, Crittenden E, Dawson CA, Bartlett KE, Westhorpe AP, Albulescu LO, Kool J, Gutiérrez JM, Casewell NR. Repurposed drugs and their combinations prevent morbidity-inducing dermonecrosis caused by diverse cytotoxic snake venoms. Nat Commun 2023; 14:7812. [PMID: 38097534 PMCID: PMC10721902 DOI: 10.1038/s41467-023-43510-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/11/2023] [Indexed: 12/17/2023] Open
Abstract
Morbidity from snakebite envenoming affects approximately 400,000 people annually. Tissue damage at the bite-site often leaves victims with catastrophic life-long injuries and is largely untreatable by current antivenoms. Repurposed small molecule drugs that inhibit specific snake venom toxins show considerable promise for tackling this neglected tropical disease. Using human skin cell assays as an initial model for snakebite-induced dermonecrosis, we show that the drugs 2,3-dimercapto-1-propanesulfonic acid (DMPS), marimastat, and varespladib, alone or in combination, inhibit the cytotoxicity of a broad range of medically important snake venoms. Thereafter, using preclinical mouse models of dermonecrosis, we demonstrate that the dual therapeutic combinations of DMPS or marimastat with varespladib significantly inhibit the dermonecrotic activity of geographically distinct and medically important snake venoms, even when the drug combinations are delivered one hour after envenoming. These findings strongly support the future translation of repurposed drug combinations as broad-spectrum therapeutics for preventing morbidity caused by snakebite.
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Affiliation(s)
- Steven R Hall
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- Centre for Drugs & Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Sean A Rasmussen
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 7th Floor of MacKenzie Building, 5788 University Avenue, Halifax, NS, B3H 1V8, Canada
| | - Edouard Crittenden
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Charlotte A Dawson
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Keirah E Bartlett
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Adam P Westhorpe
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Laura-Oana Albulescu
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- Centre for Drugs & Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Jeroen Kool
- Division of BioAnalytical Chemistry, Amsterdam Institute of Molecular and Life Sciences (AIMMS), Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
- Centre for Analytical Sciences Amsterdam (CASA), 1098 XH, Amsterdam, The Netherlands
| | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, PO Box 11501-2060, San José, Costa Rica
| | - Nicholas R Casewell
- Centre for Snakebite Research & Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
- Centre for Drugs & Diagnostics, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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7
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Das K, Das S, Mohakud NK, Pradhan SK, Sahu SK. Risk factors and outcome of acute kidney injury in children with snake envenomation. Trop Doct 2023; 53:441-443. [PMID: 37545383 DOI: 10.1177/00494755231192684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Our study evaluates the risk factors of acute kidney injury (AKI) in children with snake envenomation. Out of 145 cases, 54 (37%) developed AKI. Unsurprisingly, the mortality increased with oliguria and higher levels of creatinine. Bleeding manifestations were also more common among the AKI group.
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Affiliation(s)
- Kedarnath Das
- Department of Pediatrics, Sri Ram Chandra Bhanja Medical College, Cuttack, Odisha, India
| | - Siddhanta Das
- Department of Pediatrics, Sri Ram Chandra Bhanja Medical College, Cuttack, Odisha, India
| | - Nirmal Kumar Mohakud
- Department of Pediatrics, Kalinga Institute of Medical Sciences, Patia, Bhubaneswar, Odisha, India
| | - Subal Kumar Pradhan
- Department of Pediatrics, Sri Ram Chandra Bhanja Medical College, Cuttack, Odisha, India
| | - Sanjay Kumar Sahu
- Department of Pediatrics, Kalinga Institute of Medical Sciences, Patia, Bhubaneswar, Odisha, India
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8
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Pattanaik B, Mahapatra C, Karthika IK, Satapathy AK, John J, Das RR, Dwibedi B, Mahapatro S, Gulla KM. Clinical, laboratory profile and outcomes in children with snakebite from Eastern India. J Family Med Prim Care 2023; 12:1588-1592. [PMID: 37767426 PMCID: PMC10521854 DOI: 10.4103/jfmpc.jfmpc_1965_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/03/2023] [Accepted: 04/17/2023] [Indexed: 09/29/2023] Open
Abstract
Background Snakebite remains a significant public health problem worldwide, particularly in rural areas with unexpected morbidity and mortality. This study evaluated the clinical, laboratory profile and outcomes in children with snake bites from Eastern India. Methods This was a retrospective case record-based study between January 2017 and December 2021. The clinical features, complications, laboratory profiles and outcomes were analysed. Results Thirty children with snake bites were admitted during this study period. There was a male predominance with a ratio of 2.3:1. The mean age of presentation was 10.4 years. About 60% of bites occurred during the rainy season between July and September. Most bites (96%) were on lower limbs, predominantly showing vasculotoxic features followed by neurotoxic and a combined presentation. In this study, around 53% received anti-snake venom (ASV) before reaching our centre; the median time to reach our centre was 13 h. Complications such as acute kidney injury (AKI), cellulitis, shock and coagulation abnormalities were common in those who arrived early (before 6 h) than in those who reached late (after 6 h). Similarly, the mean duration of hospital stay was less for those seeking medical attention early as compared to those reaching late for treatment (4.7 days vs. 7.2 days). Twenty-six out of 30 (86.7%) were discharged without any sequelae, 3 (10%) children were left against medical advice and one died. Conclusions Snakebite remains a major health problem in children causing significant morbidity and mortality. Children, in general, especially males, are particularly vulnerable because of their playful and explorative nature and considerable time spent in outdoor activities. Preventive measures, education about avoiding traditional first aid methods and early administration of ASV reduce complications, duration of hospital stay and avoid the use of antibiotics.
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Affiliation(s)
- Biswajit Pattanaik
- Departments of Paediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chinmaya Mahapatra
- Departments of Paediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - IK Karthika
- Departments of Paediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Amit K. Satapathy
- Departments of Paediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Joseph John
- Departments of Paediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rashmi R. Das
- Departments of Paediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bhagirathi Dwibedi
- Departments of Paediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Samarendra Mahapatro
- Departments of Paediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Krishna M. Gulla
- Departments of Paediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Kakati H, Giri S, Patra A, Taye SJ, Agarwalla D, Boruah H, Choudhary G, Kalita B, K Mukherjee A. A retrospective analysis of epidemiology, clinical features of envenomation, and in-patient management of snakebites in a model secondary hospital of Assam, North-east India. Toxicon 2023; 230:107175. [PMID: 37257518 DOI: 10.1016/j.toxicon.2023.107175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
Assam, a Northeastern State of India, is inhabited by several venomous snake species causing substantial morbidity and mortality. The data on the epidemiology of snakebites and their management is underreported in this region. Hence, a secondary health-based retrospective study was carried out at Demow Model Hospital, Sivasagar, Assam, to evaluate the clinical and epidemiological profile of snakebite cases reported in this rural hospital and their management. Snakebites occurring between April 2018 to August 2022 were reviewed based on socio-demographic details of the patient, clinical symptoms, and treatment using a standard questionnaire. Out of the 1011 registered snakebite cases, 139 patients (13.7%) counted for venomous bites, among which 92 patients (66.19%) accounted for viper bites (green pit viper and Salazar's pit viper), and 30 patients (21.5%) were bitten by elapid snakes (Indian monocled Cobra, banded krait, and greater/lesser black krait). A maximum number of snakebite cases (80.5%) were reported from the interior rural villages and documented from July to September (51.3%). Elapid snake envenomed patients, except one, were successfully treated with commercial antivenom, neostigmine, and glycopyrrolate. Because commercial polyvalent antivenom against "Big Four" venomous snakes of India showed poor neutralization of pit-vipers envenomation; therefore, pit-viper bite patients were treated with repurposed drugs magnesium sulfate and glycerin compression dressing. Adverse serum reactions were reported only in 3 (11.1%) cases. The preventive measures and facilities adopted at the Demow Model Hospital significantly reduce snakebite death and morbidity; therefore, they can be s practised across various states in India as a prototype.
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Affiliation(s)
- Hirakjyoti Kakati
- Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, 784028, Assam, India
| | - Surajit Giri
- Demow Government Community Health Centre, Raichai, Konwar Dihingia Gaon, Sivasagar, Assam, India.
| | - Aparup Patra
- Institute of Advanced Studies in Science and Technology, Vigyan Path Garchuk, Paschim Boragaon, Guwahati, 781035, Assam, India
| | - Simanta J Taye
- Demow Government Community Health Centre, Raichai, Konwar Dihingia Gaon, Sivasagar, Assam, India
| | - Deepak Agarwalla
- Demow Government Community Health Centre, Raichai, Konwar Dihingia Gaon, Sivasagar, Assam, India
| | - Hridoy Boruah
- Demow Government Community Health Centre, Raichai, Konwar Dihingia Gaon, Sivasagar, Assam, India
| | - Gaurav Choudhary
- Demow Government Community Health Centre, Raichai, Konwar Dihingia Gaon, Sivasagar, Assam, India
| | - Bhargab Kalita
- Amrita School of Nanosciences and Molecular Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, 682041, Kerala, India
| | - Ashis K Mukherjee
- Department of Molecular Biology and Biotechnology, School of Sciences, Tezpur University, Tezpur, 784028, Assam, India; Institute of Advanced Studies in Science and Technology, Vigyan Path Garchuk, Paschim Boragaon, Guwahati, 781035, Assam, India.
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10
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Gopal G, Muralidar S, Prakash D, Kamalakkannan A, Indhuprakash ST, Thirumalai D, Ambi SV. The concept of Big Four: Road map from snakebite epidemiology to antivenom efficacy. Int J Biol Macromol 2023; 242:124771. [PMID: 37169043 DOI: 10.1016/j.ijbiomac.2023.124771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
Snake envenomation is a life-threatening disease caused by the injection of venom toxins from the venomous snake bite. Snakebite is often defined as the occupational or domestic hazard mostly affecting the rural population. India experiences a high number of envenoming cases and fatality due to the nation's diversity in inhabiting venomous snakes. The Indian Big Four snakes namely Russell's viper (Daboia russelii), spectacled cobra (Naja naja), common krait (Bungarus caeruleus), and saw-scaled viper (Echis carinatus) are responsible for majority of the snake envenoming cases and death. The demographic characteristics including occupation, stringent snake habitat management, poor healthcare facilities and ignorance of the rural victims are the primary influencers of high mortality. Biogeographic venom variation greatly influences the clinical pathologies of snake envenomation. The current antivenoms against the Big Four snakes are found to be less immunogenic against the venom toxins emphasizing the necessity of alternative approaches for antivenom generation. This review summarizes the burden of snake envenomation in India by the Big Four snakes including the geographic distribution of snake species and biogeographic venom variation. We have provided comprehensive information on snake venom proteomics that has aided the better understanding of venom induced pathological features, summarized the impact of current polyvalent antivenom therapy highlighting the need for potential antivenom treatment for the effective management of snakebites.
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Affiliation(s)
- Gayathri Gopal
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Shibi Muralidar
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Diwahar Prakash
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Abishek Kamalakkannan
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Srichandrasekar Thuthikkadu Indhuprakash
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Diraviyam Thirumalai
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Senthil Visaga Ambi
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India.
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Bogati S, Bhatt N, Nepal S, Nepali P, Sharma SK. Snakebite in the Hills and Mountains of Nepal. JNMA J Nepal Med Assoc 2022; 60:1066-1069. [PMID: 36705115 PMCID: PMC9795130 DOI: 10.31729/jnma.7562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/20/2022] [Indexed: 12/03/2022] Open
Abstract
Snakebite is an important public health issue around the world. In Nepal, it affects a huge number of people mostly belonging to low-income households who are involved in agriculture. Although snakebite has a serious impact on the Terai population, a few studies suggest that snakebite also occurs frequently in hills and mountains. In the absence of sufficient studies related to snakebites in these geographical regions, it is tough to sketch a true picture and estimate the magnitude of snakebites in those areas. Because of this, the healthcare system is probably not prepared enough to handle the victims of snakebites. This demands a proper study of the burden of the issue in these regions and appropriate initiatives for addressing it. Keywords antivenom; Nepal; snakebite.
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Affiliation(s)
- Sunil Bogati
- Kolhabi Primary Health Care Center, Kalaiya, Bara, Nepal,Correspondence: Dr Sunil Bogati, Kolhabi Primary Health Care Center, Kalaiya, Bara, Nepal. , Phone: +977-9849453341
| | - Navin Bhatt
- Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Shristi Nepal
- Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | | | - Sanjib Kumar Sharma
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
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Ortiz-Prado E, Yeager J, Andrade F, Schiavi-Guzman C, Abedrabbo-Figueroa P, Terán E, Gómez-Barreno L, Simbaña-Rivera K, Izquierdo-Condoy JS. Snake antivenom production in Ecuador: Poor implementation, and an unplanned cessation leads to a call for a renaissance. Toxicon 2021; 202:90-97. [PMID: 34571098 DOI: 10.1016/j.toxicon.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 11/28/2022]
Abstract
Snakebite envenomation is a global health problem. This health problem asymmetrically affects rural populations in developing countries to such an extent that it recently has been listed as a priority neglected tropical disease (NTD). It is estimated that 5.4 million individuals are bitten by snakes each year, causing at least 2.7 million envenomations and more than 100,000 deaths each year. Ecuador has one of the highest snakebite envenomation incidence rates in Latin America, mostly in the coastal and Amazonian provinces. Envenomations in these regions are the result of bites primarily by species of snakes belonging to the Viperidae family. Ecuador was able to locally produce antivenoms, however serious flaws were revealed in the antivenom production process, leading to the decommissioning of the existing facility. In the interest of public health, we have summarized the political and social setbacks experienced by the antivenom serum production plant in Ecuador, while encouraging resuming local production of snake antivenom to improve the responsiveness of the already overburdened health system.
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Affiliation(s)
- Esteban Ortiz-Prado
- OneHealth Global Research Group, Universidad de las Américas, Quito, Ecuador.
| | - Justin Yeager
- Biodiversity, Environment, and Health (BIOMAS), Universidad de las Americas, Quito, Ecuador
| | - Felipe Andrade
- OneHealth Global Research Group, Universidad de las Américas, Quito, Ecuador
| | | | | | - Enrique Terán
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Lenin Gómez-Barreno
- OneHealth Global Research Group, Universidad de las Américas, Quito, Ecuador
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Kumar A, Raina SK, Raina S. Snakebite profile from a tertiary care setup in a largely rural setting in the hills of North-West India. J Family Med Prim Care 2021; 10:2793-2797. [PMID: 34660407 PMCID: PMC8483123 DOI: 10.4103/jfmpc.jfmpc_2377_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/06/2021] [Accepted: 02/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Snakebite, a medical emergency, faced by rural populations in tropical and subtropical countries assumes special significance in hilly terrains. Therefore, the hills provide a natural setting to study the challenges in the management of snakebite cases. Methodology: A hospital record-based retrospective descriptive study was conducted. Data were collected from the Medical Records Department of the 821-bedded, tertiary care hospital catering to the rural hilly population of the state of Himachal Pradesh, India. Information were recorded on details of demography, clinical profile treatment and outcome. Results: A total of 252 patients were analyzed. Maximum patients were in the age-group of 21–40 (43.7%) with mean and standard deviation of 30.52 ± 5.693 and 31.81 ± 7.117 for male and female, respectively. A small minority (17.06%) of patients reported to health facility within 4–6 h of the bite. Maximum bites were on lower limb (143;56.74). Overall mortality rate in our study was 2.38%. Conclusion: Large-scale studies on epidemiological determinants of snakebite coupled with research in venom biochemistry and bio-pharmacology of anti-snake venom (ASV) are needed. The study also provides insights into the role of primary care practitioners in creating an ecosystem favorable for snakebite management at local level.
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Affiliation(s)
- Anil Kumar
- RHFWTC, Chheb, Kangra, Himachal Pradesh, India
| | - Sunil K Raina
- Department of Community Medicine, Dr. RP Government Medical College, Tanda, Himachal Pradesh, India
| | - Sujeet Raina
- Department of Internal Medicine, Dr. RP Government Medical College, Tanda, Himachal Pradesh, India
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Patel S, Patel A, Ganjiwale J, Patel D, Nimbalkar S. The study of clinical profile and outcome of patients with snakebite in a rural community. J Family Med Prim Care 2021; 10:1661-1665. [PMID: 34123909 PMCID: PMC8144800 DOI: 10.4103/jfmpc.jfmpc_1976_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/02/2020] [Accepted: 01/05/2021] [Indexed: 11/21/2022] Open
Abstract
Context: Snakebite remains an underrated cause of accidental death in modern India, primarily in rural India, where people fail to reach out to modern medicine and fall victim to the handful of quacks using traditional healing methods. If promptly diagnosed and treated based on various clinical determinants like mode of presentation, time of medical intervention, recognition of the species, and analysis of a series of reliably identified bites, the treatment outcome would be more promising. We aimed to study snakebite patients' clinical profile and treatment outcome in a rural tertiary care setup. Materials and Method: This is a retrospective study in which the data evaluated from an epidemiological viewpoint; gender and age of the snake bite victim, time when bitten, interval between the bite and medical consultation, pattern of toxicity, and response to anti-snake venom (ASV). Results: Of a total of 200 patients bitten by a snake, 121 were males, with 77% adults. In nearly all cases, the type of snake was unknown; however, most of the bites were poisonous, showing one or the other type of toxicity. One hundred seventy-one patients survived the snake bite, and 29 succumbed. When Logistic regression was done with Death/discharge as the dependent variable and “Time to bite and reaching hospital, Age, Sex, number of ASV given, Ventilation needed or not, pack cell volume (PCV) numbers, Fresh Frozen Plasma (FFP) numbers, Dialysis and presence or absence of toxicity” as the independent variables, the model developed did not account for any respectable amount of variation in the outcome. The only variable found to be predicting the outcome significantly was FFP. Conclusion: It is often difficult to identify the type of snake, and thus polyvalent antisnake venom remains the only available treatment resource. Readily available treatment resources, timely intervention, appropriate referral, and close ICU will alleviate mortality.
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Affiliation(s)
- Samirkumar Patel
- Department of Medicine, Shree Krishna Hospital and Pramukhswami Medical College, Bhaikaka University Karamsad, Anand, Gujarat, India
| | - Aayushi Patel
- Department of Neonatology, Shree Krishna Hospital and Pramukhswami Medical College, Bhaikaka University Karamsad, Anand, Gujarat, India
| | - Jaishree Ganjiwale
- Department of Community Medicine and Central Research Services, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Dhaval Patel
- Vidyanagar Nature Club/Voluntary Nature Conservancy, Vallabh Vidyanagar, Gujarat, India
| | - Somashekhar Nimbalkar
- Department of Neonatology, Shree Krishna Hospital and Pramukhswami Medical College, Bhaikaka University Karamsad, Anand, Gujarat, India
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Jayawardana S, Arambepola C, Chang T, Gnanathasan A. Prevalence, vulnerability and epidemiological characteristics of snakebite in agricultural settings in rural Sri Lanka: A population-based study from South Asia. PLoS One 2020; 15:e0243991. [PMID: 33370325 PMCID: PMC7769266 DOI: 10.1371/journal.pone.0243991] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 12/01/2020] [Indexed: 12/20/2022] Open
Abstract
Background The burden of snakebite remains poorly characterised because of the paucity of population-based data. Further, factors determining the vulnerability of individuals within rural communities to snakebite have been rarely investigated. We undertook a population-based study to determine the prevalence, vulnerability and epidemiological characteristics of snakebite in rural Sri Lanka. Methods and findings A population-based cross-sectional study was conducted among 8707 current residents in the district of Ampara, representing typical rural Sri Lanka. The sample was recruited using multi-stage cluster sampling with probability proportionate-to-size. Snakebite victims were identified using the WHO criteria. Data were collected using a pre-tested interviewer-administered questionnaire. Each household had on average 3.8 persons; mean age 28.3 years (SD = 18.2); 51.3% males. The one-year point prevalence of snakebites was 17.6 per 1000 residents (95% CI: 15–20.6) and 6.12 per 100 households (95% CI: 5.25–7.13), while the lifetime prevalence was 9.4 per 100 residents (95% CI: 8.8–10.0) and 30.5 per 100 households (95% CI: 28.6–32.2) with a case fatality ratio of 0.033. Venomous snakebites accounted for 28.1%; snakes were unidentified among 30.1%. Compared to the non-snakebite victims, being single, males, of Sinhala ethnicity, aged >19 years, low education and socioeconomic status, engaging in farming or unskilled outdoor occupations denoted vulnerability to snakebites. Outdoor bites (77.8%) were more common among males; during daytime; mostly while walking; within the rural terrains and home gardens; on lower limbs; mostly by hump-nosed and Russell viper. Indoor bites were more common among females; during night-time; while sleeping and barefooted; on lower limbs; mostly by hump-nosed vipers, kraits and non-venomous snakes. Conclusions The burden of snakebite is considerably high among rural populations. The concept of vulnerability can be useful in healthcare decision-making and resource allocation.
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Affiliation(s)
- Subashini Jayawardana
- Faculty of Medicine, Department of Allied Health Sciences, University of Colombo, Colombo, Sri Lanka
| | - Carukshi Arambepola
- Faculty of Medicine, Department of Community Medicine, University of Colombo, Colombo, Sri Lanka
- * E-mail:
| | - Thashi Chang
- Faculty of Medicine, Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ariaranee Gnanathasan
- Faculty of Medicine, Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka
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Salve PS, Vatavati S, Hallad J. Clustering the envenoming of snakebite in India: The district level analysis using Health Management Information System data. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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A Study of the Pattern of Admissions to the Accident and Emergency (A&E) Department of a Tertiary Care Hospital in Sri Lanka. Emerg Med Int 2020; 2020:6327293. [PMID: 32855825 PMCID: PMC7443021 DOI: 10.1155/2020/6327293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction The latest national healthcare reform policies of Sri Lanka include the development of accident and emergency (A&E) departments in all major hospitals. Provincial General Hospital Kurunegala (PGHK) is a home to the first established A&E department in Sri Lanka. PGHK provides services to a population of 2.4 million spread out in the North Western Province and part of the Sabaragamuwa Province. This study was carried out to identify the pattern of all admissions to the A&E department of PGHK. Methods The prospective observational study was carried out from July 1, 2016, to June 30, 2017 (one year) to identify the pattern of admissions to the A&E department. Results There were 49,213 admissions to PGHK's A&E department during the study period. The average number of admissions was 135 (±17.9) per day. The percentage of deaths in the A&E department was 0.21%. The mean age of admitted patients was 46.7 (±21.7) years. A further 62% of admitted patients were males. The number of medical, surgical, paediatric, and gynaecological and obstetrical admissions was 55%, 42%, 3.5%, and 0.22%, respectively. Among the common emergency medical presentations, 34% were chest pain, 11% patients presented with unilateral weakness and/or slurring of speech, 10% covered dyspnoea, and 9% complained of dizziness/giddiness. Among emergency surgical presentations, 83% were trauma due to accidents, of which 27% were road-traffic-related accidents (RTAs). Discussion. The A&E department of PGHK provides services to a significantly high number of health emergencies every day. The majority of these admissions was due to chest pain and trauma related to accidents. The lower recorded number of paediatric and gynaecological and obstetrical emergencies presented to the A&E department is a result of a government policy mandating the admission of these types of patients directly to their respective wards. Further infrastructure development, staff recruitment, and training have to be planned and implemented to address the significantly high number of admissions to the A&E Department of PGHK.
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Assessing the Increase of Snakebite Incidence in Relationship to Flooding Events. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020. [DOI: 10.1155/2020/6135149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Snakebite envenoming causes up to 138,000 deaths and 400,000 permanently disabled victims worldwide every year. Flooding is one of the many factors that seems to influence the incidence of snakebite. The catastrophic floods from late 2018 in Kerala (India) were widely broadcast and are an example of how flooding events are related to the increased incidence of snakebite. This relationship has been mentioned regularly in scientific and grey literature, but usually quite scarcely in comparison to other topics linked to snakebite. Additionally, web media, mobile communications, and social media have started playing an important role not only in providing access to information on flooding-related snakebite events, but also in snakebite prevention at a larger scale. In order to better understand to what extent the relationship between snakebite incidence and flooding is reported and quantified and appraise the importance of mobile communications and social media in snakebite prevention and management, we performed multiple searches in generic (Google) and specialized (PubMed, Web of Science, Google Scholar) databases. We retrieved 68 scientific articles and 5 reports ranging from 1892 to 2018 mentioning or analyzing flooding and the increased incidence of snakebite. Additionally, we found 68 web media reports linking flooding and snakebite. This review indicates that the increase of snakebite incidence due to flooding has been repeatedly observed all over the world. This phenomenon could be exacerbated because of climate change, which is expected to increase the overall magnitude and frequency of flooding. However, it could also be mitigated by the role the Internet, mobile communications, and social media could play in snakebite prevention and human and animal rescue strategies during flooding.
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Pla D, Sanz L, Quesada-Bernat S, Villalta M, Baal J, Chowdhury MAW, León G, Gutiérrez JM, Kuch U, Calvete JJ. Phylovenomics of Daboia russelii across the Indian subcontinent. Bioactivities and comparative in vivo neutralization and in vitro third-generation antivenomics of antivenoms against venoms from India, Bangladesh and Sri Lanka. J Proteomics 2019; 207:103443. [PMID: 31325606 DOI: 10.1016/j.jprot.2019.103443] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/14/2019] [Indexed: 02/07/2023]
Abstract
Russell's viper (Daboia russelii) is, together with Naja naja, Bungarus caeruleus and Echis carinatus, a member of the medically important 'Big Four' species responsible for causing a large number of morbidity and mortality cases across the Indian subcontinent. Despite the wide distribution of Russell's viper and the well-documented ubiquity of the phenomenon of geographic variability of intraspecific snake venom composition, Indian polyvalent antivenoms against the "Big Four" venoms are raised against venoms sourced mainly from Chennai in the southeastern Indian state of Tamil Nadu. Biochemical and venomics investigations have consistently revealed notable compositional, functional, and immunological differences among geographic variants of Russell's viper venoms across the Indian subcontinent. However, these studies, carried out by different laboratories using different protocols and involving venoms from a single geographical region, make the comparison of the different venoms difficult. To bridge this gap, we have conducted bioactivities and proteomic analyses of D. russelii venoms from the three corners of the Indian subcontinent, Pakistan, Bangladesh, and Tamil Nandu (India) and Sri Lanka, along with comparative in vivo neutralization and in vitro third-generation antivenomics of antivenoms used in India, Bangladesh and Sri Lanka. These analyses let us to propose two alternative routes of radiation for Russell's viper in the Indian subcontinent. Both radiations, towards the northeast of India and Bangladesh and towards south India and Sri Lanka, have a common origin in Pakistan, and provide a phylovenomics ground for rationalizing the geographic variability in venom composition and their distinct immunoreactivity against available antivenoms. BIOLOGICAL SIGNIFICANCE: Russell's viper (Daboia russelii), the Indian cobra (Naja naja), the common krait (Bungarus caeruleus), and the saw-scaled viper (Echis carinatus) constitute the 'Big Four' snake species responsible for most snakebite envenomings and deaths in the Indian subcontinent. Despite the medical relevance of Daboia russelii, and the well documented variations in the clinical manifestations of envenomings by this wide distributed species, which are doubtless functionally related to differences in venom composition of its geographic variants, antivenoms for the clinical treatment of envenomings by D. russelii across the Indian subcontinent are invariably raised using venom sourced mainly from the southeastern Indian state of Tamil Nadu. We have applied a phylovenomics approach to compare the venom proteomes of Russell's vipers from the three corners of the Indian subcontinent, Pakistan, Bangladesh, and South India/Sri Lanka, and have assessed the in vitro (third-generation antivenomics) and in vivo preclinical efficacy of a panel of homologous antivenoms. The identification of two dispersal routes of ancestral D. russelii into the Indian subcontinent provides the ground for rationalizing the variability in composition and immunoreactivity of the venoms of extant geographic variants of Russell's viper. Such knowledge is relevant for envisioning strategies to improve the clinical coverage of anti- D. russelii antivenoms.
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Affiliation(s)
- Davinia Pla
- Evolutionary and Translational Venomics Laboratory, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain
| | - Libia Sanz
- Evolutionary and Translational Venomics Laboratory, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain
| | - Sarai Quesada-Bernat
- Evolutionary and Translational Venomics Laboratory, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain
| | - Mauren Villalta
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José 11501-2060, Costa Rica
| | - Joshua Baal
- Technische Universität Kaiserslautern, Erwin-Schrödinger-Straße 52, 67663 Kaiserslautern, Germany
| | | | - Guillermo León
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José 11501-2060, Costa Rica.
| | - José M Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José 11501-2060, Costa Rica.
| | - Ulrich Kuch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
| | - Juan J Calvete
- Evolutionary and Translational Venomics Laboratory, Consejo Superior de Investigaciones Científicas (CSIC), Valencia, Spain.
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Mana K, Ghosh R, Gantait K, Saha K, Parua P, Chatterjee U, Sarkhel S. Incidence and treatment of snakebites in West Bengal, India. Toxicol Rep 2019; 6:239-243. [PMID: 30899676 PMCID: PMC6409390 DOI: 10.1016/j.toxrep.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/20/2019] [Accepted: 02/24/2019] [Indexed: 11/27/2022] Open
Abstract
Objective Snake envenomation is a major cause of death and disability in the developing countries. In India and neighboring countries, the four venomous snakes of concern include – Indian cobra(Naja naja), Common Krait (Bungarus caeruleus); Russell's Viper (Daboia russelli); Saw Scaled Viper (Echis carinatus). We describe the management protocol for snakebite treatment in a tertiary care hospital of Paschim Medinipur district, West Bengal based on case reports of subjects admitted and treated in Ghatal Subdivisional Hospital(GSH) during 2013–2016. Methods &materials We developed a structured data collection form to record demographic and clinical details of patients hospitalized at GSH between 1 January 2013 through 31 December 2016. Results Snake bite cases in Ghatal Subdivisional hospital(GSH) were assessed during the period 2013–2016. A total 18 deaths due to snakebite has been reported from this tertiary care hospital during the period. Total patients admitted in this hospital with snakebite is 1160 during the period 2013–2016. In 80% of the cases the lower extremities were affected. Preliminary first aid was provided in 45% cases. About 65% of the affected victims suffered snakebite in the morning hours. Some of the recommended drugs that were prescribed by the physicians of GSH were neostigmine, atropine, adrenaline, hydrocortisone, Amoxicillin. WBCT20 and Urea, Creatinine level were routinely performed. Conclusion Hospital studies are a key source of information about snake bites. The ready availability and appropriate use of AVS, close monitoring of patients, the institution of ventilator support and if required, early referral to a larger hospital all help to reduce the mortality. Thus knowledge of the varied clinical manifestations of snake bite is important for effective management in hospitals by a complete health care team.
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Affiliation(s)
- Kaushik Mana
- Department of Human Physiology with Community Health, Vidyasagar University, Paschim Medinipur, 721102, West Bengal, India
| | - Rituparna Ghosh
- Department of Medicine, Midnapur Medical College, Paschim Medinipur, 721102, West Bengal, India
| | - Kripasindhu Gantait
- Department of Human Physiology with Community Health, Vidyasagar University, Paschim Medinipur, 721102, West Bengal, India
| | - Kanchan Saha
- Department of Human Physiology with Community Health, Vidyasagar University, Paschim Medinipur, 721102, West Bengal, India
| | - Poulami Parua
- Department of Human Physiology with Community Health, Vidyasagar University, Paschim Medinipur, 721102, West Bengal, India
| | - Upasana Chatterjee
- Department of Human Physiology with Community Health, Vidyasagar University, Paschim Medinipur, 721102, West Bengal, India
| | - Sumana Sarkhel
- Department of Human Physiology with Community Health, Vidyasagar University, Paschim Medinipur, 721102, West Bengal, India
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Dang A, Panwar S. A retrospective analysis of snake envenomation in the intensive care unit of a tertiary care hospital in Delhi. JOURNAL OF ACUTE DISEASE 2019. [DOI: 10.4103/2221-6189.263710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kandiwa E, Mushonga B, Samkange A, Fabiano E. Quantitative Characterization of the Hemorrhagic, Necrotic, Coagulation-Altering Properties and Edema-Forming Effects of Zebra Snake ( Naja nigricincta nigricincta) Venom. J Toxicol 2018; 2018:6940798. [PMID: 30473709 PMCID: PMC6220379 DOI: 10.1155/2018/6940798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 11/18/2022] Open
Abstract
This study was designed to investigate the cytotoxicity and haemotoxicity of the Western barred (zebra) spitting cobra (Naja nigricincta nigricincta) venom to help explain atypical and inconsistent reports on syndromes by Namibian physicians treating victims of human ophidian accidents. Freeze-dried venom milked from adult zebra snakes was dissolved in phosphate buffered saline (PBS) for use in this study. Haemorrhagic and necrotic activity of venom were studied in New Zealand albino rabbits. Oedema-forming activity was investigated in 10-day-old Cobb500 broiler chicks. Procoagulant and thrombolytic activity was investigated in adult Kalahari red goat blood in vitro. The rabbit skin minimum hemorrhagic dose (MHD) for N. n. nigricincta was 9.8μg. The minimum necrotizing dose (MND) for N. n. nigricincta venom was 12.2μg. The N. n. nigricincta venom showed linear dose-dependent procoagulant activity on goat blood (p<0.05). Likewise, N. n. nigricincta venom showed linear dose-dependent thrombolytic activity on goat blood (p<0.05, n = 6). Subplantar injection of N. n. nigricincta venom (25μg, 50μg, 75μg, and 100μg) into chick paw resulted in peak oedema of 35.5%, 38.5%, 42.9%, and 47.5%, respectively, two hours after injection. Paw oedema subsided within five hours to a mean volume ranging from 5% (25μg venom) to 17.6% (100μg venom). In conclusion, though N. n. nigricincta belongs to the genus Elapidae, the current study has shown its venom to possess potent hemorrhagic, necrotic (cytotoxic), and paradoxically, both procoagulant and thrombolytic activity. The authors propose further work to fractionate, isolate, and elucidate the structure of the various N. n. nigricincta venom toxins as a prelude to the development of an antivenom.
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Affiliation(s)
- Erick Kandiwa
- School of Veterinary Medicine, Faculty of Agriculture and Natural Resources, Neudamm Campus, University of Namibia, P. Bag 13301, Pioneers Park, Windhoek, Namibia
| | - Borden Mushonga
- School of Veterinary Medicine, Faculty of Agriculture and Natural Resources, Neudamm Campus, University of Namibia, P. Bag 13301, Pioneers Park, Windhoek, Namibia
| | - Alaster Samkange
- School of Veterinary Medicine, Faculty of Agriculture and Natural Resources, Neudamm Campus, University of Namibia, P. Bag 13301, Pioneers Park, Windhoek, Namibia
| | - Ezequiel Fabiano
- Department of Wildlife Management and Ecotourism, Katima Mulilo Campus, Faculty of Agriculture and Natural Resources, University of Namibia, P. Bag 1096, Ngweze, Katima Mulilo, Namibia
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Pulimaddi R, Parveda AR, Brahmanpally B, Kalakanda PM, Ramakrishna K, Chinnapaka VRD. Incidence & prognosis of acute kidney injury in individuals of snakebite in a tertiary care hospital in India. Indian J Med Res 2018; 146:754-758. [PMID: 29664034 PMCID: PMC5926347 DOI: 10.4103/ijmr.ijmr_1581_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background & objectives: The snakebites are considered to be an occupational hazard in agriculture workers and the snake handlers, resulting in a considerable morbidity, mortality and economical implications. This study was conducted to determine the incidence, clinical presentation, renal injury and clinical outcome in snakebite victims who developed acute kidney injury (AKI). Methods: This hospital-based prospective, observational study was done on 100 cases who were admitted for the management of snakebite and found to develop AKI in a tertiary care hospital at Hyderabad, India. Renal function tests, complete blood picture, urine routine examination, ultrasound examination of abdomen and coagulation profile were done and the prognosis was assessed by noting recovery, mortality, morbidity and/or progress to chronic stage. Results: A total of 100 patients with a mean age of 43.80±12.63 yr (range 18-70); 62 males and 38 females were studied. All had bites on lower limbs. A total of 86 patients arrived in the hospital within 24 h, and 14 arrived after 24 h. Oliguria was found in 60, bleeding tendencies in 64, haemodynamic instability noted - tachycardia in 86. Systolic blood pressure (BP) was <120 mm Hg in 68 and BP was not recordable in four patients. Twelve patients were in stage III kidney disease and needed haemodialysis. Of the 100 cases of snakebite-induced acute kidney failure, 86 recovered and six died. On follow up, after six months eight patients developed chronic kidney failure. Interpretation & conclusions: A cascade of events tends to occur in severe haemotoxic envenomation such as bleeding disorders, hypotension/circulatory shock, intravascular haemolysis, disseminated intravascular coagulation and acute respiratory disease syndrome (ARDS). The findings of this study showed that early hospitalization, quick antisnake venom administration and adequate supporting care provided promising results.
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Affiliation(s)
- Ramulu Pulimaddi
- Department of General Medicine, Osmania Medical College, Hyderabad, India
| | | | | | - Paul Marx Kalakanda
- Department of Biochemistry, University College of Science, Osmania University, Hyderabad, India
| | - K Ramakrishna
- Department of General Medicine, Osmania Medical College, Hyderabad, India
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Bulfone TC, Samuel SP, Bickler PE, Lewin MR. Developing Small Molecule Therapeutics for the Initial and Adjunctive Treatment of Snakebite. J Trop Med 2018; 2018:4320175. [PMID: 30154870 PMCID: PMC6091453 DOI: 10.1155/2018/4320175] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/03/2018] [Indexed: 01/19/2023] Open
Abstract
The World Health Organization (WHO) recently added snakebite envenoming to the priority list of Neglected Tropical Diseases (NTD). It is thought that ~75% of mortality following snakebite occurs outside the hospital setting, making the temporal gap between a bite and antivenom administration a major therapeutic challenge. Small molecule therapeutics (SMTs) have been proposed as potential prereferral treatments for snakebite to help address this gap. Herein, we discuss the characteristics, potential uses, and development of SMTs as potential treatments for snakebite envenomation. We focus on SMTs that are secretory phospholipase A2 (sPLA2) inhibitors with brief exploration of other potential drug targets on venom molecules.
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Affiliation(s)
- Tommaso C. Bulfone
- California Academy of Sciences, San Francisco, 94118 CA, USA
- Ophirex, Inc., Corte Madera, 94925 CA, USA
- University of California, San Francisco, 94118 CA, USA
| | - Stephen P. Samuel
- California Academy of Sciences, San Francisco, 94118 CA, USA
- General Medicine, Queen Elizabeth Hospital, King's Lynn, PE30 4ET, Norfolk, UK
| | | | - Matthew R. Lewin
- California Academy of Sciences, San Francisco, 94118 CA, USA
- Ophirex, Inc., Corte Madera, 94925 CA, USA
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El hattimy F, Chafiq F, Hami H, Mokhtari A, Soulaymani A, Rachida SB. Geographical distribution of health indicators related to snake bites and envenomation in Morocco between 1999 and 2013. Epidemiol Health 2018; 40:e2018024. [PMID: 29909610 PMCID: PMC6178366 DOI: 10.4178/epih.e2018024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/16/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Envenomation from snake bites is a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the epidemiological features of snake bites in Morocco and to evaluate time-space trends in snake bite incidence, the mortality rate, and the case-fatality rate. METHODS This is a retrospective study of snake bite cases reported to the Moroccan Poison Control Center between 1999 and 2013. RESULTS During the study period, 2,053 people were bitten by snakes in Morocco. Most victims were adults (55.4%). The average age of the patients was 26.48±17.25 years. More than half of the cases (58.1%) were males. Approximately 75% of snake bites happened in rural areas, and 85 deaths were recorded during this period. The incidence of snake bites remained generally steady over the 15-year period of this study, with a marked increase noted since 2012. The mortality rate has increased slightly, from 0.02 deaths per 100,000 inhabitants in 1999 to 0.05 in 2013. The geographical distribution of snake bite cases in the regions of Morocco showed that Tanger-Tétouan had the highest annual incidence of snake bites (1.41 bites per 100,000 inhabitants). However, the highest annual mortality rates were recorded in the Guelmim-Es Semara and Souss-Massa-Drâa regions (0.09 deaths per 100,000 inhabitants for both regions). CONCLUSIONS The geographical distribution of the incidence, mortality, and case-fatality rates of snake bites in Morocco showed large disparities across regions during the three 5-year periods included in this study, meaning that certain areas can be considered high-risk for snake bites.
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Affiliation(s)
- Faiçal El hattimy
- Laboratory of Genetics and Biometry, Faculty of Science, Ibn Tofail University, Kenitra, Morocco
| | - Fouad Chafiq
- Moroccan Anti-Poison and Pharmacovigilance Center, Rabat, Morocco
| | - Hinde Hami
- Laboratory of Genetics and Biometry, Faculty of Science, Ibn Tofail University, Kenitra, Morocco
| | - Abdelghani Mokhtari
- Laboratory of Genetics and Biometry, Faculty of Science, Ibn Tofail University, Kenitra, Morocco
| | - Abdelmajid Soulaymani
- Laboratory of Genetics and Biometry, Faculty of Science, Ibn Tofail University, Kenitra, Morocco
| | - Soulaymani Bencheikh Rachida
- Moroccan Anti-Poison and Pharmacovigilance Center, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Ghosh R, Mana K, Gantait K, Sarkhel S. A retrospective study of clinico-epidemiological profile of snakebite related deaths at a Tertiary care hospital in Midnapore, West Bengal, India. Toxicol Rep 2017; 5:1-5. [PMID: 29234603 PMCID: PMC5723283 DOI: 10.1016/j.toxrep.2017.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 11/24/2022] Open
Abstract
In the present epidemiological study, the total number of reported snakebite deaths in Midnapore Medical College and Hospital(MMCH) during the period 2012–2016 was 222, of which number of males was 134 (60.36%) and female 88 (39.63%). The case fatality rate of the hospital was 3.5%. Out of the 222 cases of snakebite, 182 (82%) cases were due to viper envenomation. Maximum snakebite deaths occurred in the age group of 31–40 years and most of the snakebites occurred during June- September (n = 182 cases). Most of the cases reported bites in the lower extremities(71%;158 cases) followed by upper limb and chest(29%, 64 cases). The mean bleeding time of the snakebite cases was 12.55 ± 3.2 min (n = 190 cases). The mean clotting time was found to be 20.1 ± 2.55 min (n = 190 cases). WBCT20 was repeated every 6 h until two consecutive (WBCT20) were clotted. All patients were treated with Polyvalent Haffkine® anti-snake venom. For management of neurotoxic envenomation maximum 20 vials of AVS was given and maximum prescribed AVS for haemotoxic bite was 13 vials.
Objective Snakebite is one of the neglected tropical diseases that World Health Organization (WHO) aimed to eradicate. The objective of the study is to investigate the mortality and morbidity due to snakebite at Midnapore Medical College & Hospital in Paschim Medinipur district, West Bengal, India. Methods & materials This is a record-based, retrospective, descriptive epidemiological study conducted from January 2012 to December 2016 at Midnapore Medical College and Hospital(MMCH), Paschim Medinipur district, West Bengal. The incidence and determinants of snakebite related mortality with reference to types of envenomation, age, sex, site of bite, clinical manifestations of snakebite, bite to hospital and bite to AVS treatment time, first aid and management of snakebite were investigated during the study. The data was analyzed by SPSS (Version 18) software.All results were expressed as percentage. Results Total number of snakebite deaths in Midnapore Medical College and Hospital(MMCH) was 222 from the period 2012–2016. Number of males was 134(60.36%) and female 88 (39.63%). Maximum snakebite deaths occurred in the age group of 31–40 years during agricultural and outdoor activities. Most of the snakebites occurred during June-September. Out of the 222 cases of snakebite, 182(82%) cases were due to viper envenomation. Maximum number of cases(n = 162) were detected in the interval between 4.00 PM to 8.00 PM. The bite to hospital time was found to be 180 ± 3.5 mins (n = 190 cases) and bite to AVS injection time was found to be 240 ± 3.5 mins (n = 190 cases). The mean bleeding time was 12.55 ± 3.2 min (n = 190 cases). The mean clotting time was found to be 20.1 ± 2.55 min (n = 190 cases). The symptoms of envenomation included local signs of inflammation(100% cases), blisters and necrosis (45% cases), renal failure (20% cases), coagulopathies(57% cases), ptosis(10% cases), dysphagia(2%) and respiratory distress(15% cases). The WHO protocol for snakebite management was followed for treatment of snakebite victims. Conclusion Snake bite is a neglected, life-threatening emergency in developing countries such as India and demands immediate anti-venom therapy. Hospital studies are a key source of information about snake bites. The ready availability and appropriate use of AVS, close monitoring of patients, the institution of ventilator support and if required, early referral to a larger hospital all help to reduce the mortality. Thus knowledge of the varied clinical manifestations of snake bite is important for effective management in hospitals by a complete health care team.
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Affiliation(s)
- Rituparna Ghosh
- Department of Human Physiology with Community Health, Vidyasagar University, Paschim Medinipur, 721102, West Bengal, India
| | - Koushik Mana
- Department of Human Physiology with Community Health, Vidyasagar University, Paschim Medinipur, 721102, West Bengal, India
| | - Kripasindhu Gantait
- Department of Medicine, Midnapur Medical College, Paschim Medinipur, 721102, West Bengal, India
| | - Sumana Sarkhel
- Department of Human Physiology with Community Health, Vidyasagar University, Paschim Medinipur, 721102, West Bengal, India
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Chandrakumar A, Suriyaprakash T, Mohan PL, Thomas L, Vikas P. Evaluation of demographic and clinical profile of snakebite casualties presented at a tertiary care hospital in Kerala. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2016. [DOI: 10.1016/j.cegh.2015.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Pore SM, Ramanand SJ, Patil PT, Gore AD, Pawar MP, Gaidhankar SL, Ghanghas RR. A retrospective study of use of polyvalent anti-snake venom and risk factors for mortality from snake bite in a tertiary care setting. Indian J Pharmacol 2016; 47:270-4. [PMID: 26069363 PMCID: PMC4450551 DOI: 10.4103/0253-7613.157117] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 03/18/2015] [Accepted: 04/12/2015] [Indexed: 11/04/2022] Open
Abstract
AIMS Envenomation with poisonous snakes is associated with considerable morbidity and mortality. The present study was undertaken with the objectives of assessing anti-snake venom (ASV) use, early adverse reactions to ASV, premedication and clinical outcomes in snake bite patients. Association of various risk factors (age, gender, dose of ASV, time gap between snake bite and ASV administration, use of mechanical ventilation and type of snake bite) with mortality was also assessed. SETTINGS AND DESIGN This retrospective study was conducted at two Tertiary Care Teaching Hospitals. SUBJECTS AND METHODS The medical records of 176 patients of snake bite with documented use of ASV were retrospectively analyzed to retrieve relevant data. STATISTICAL ANALYSIS Descriptive statistics was used to express results about ASV use, early adverse reactions to ASV, premedication and clinical outcomes. Univariate and multivariate analysis was performed to find out significant risk factors associated with mortality. RESULTS The main indication for ASV was vasculotoxic snake bite (75%) followed by neurotoxic snake bite (16%). Mean dose of ASV was 18.63 ± 14.52 vials. Prophylactic premedication with corticosteroids alone or in combination with antihistaminic was used in more than 70% patients. Early adverse reactions to ASV were seen in 4% patients. Neurotoxic snake bite was a significant risk factor associated with mortality in multivariate analysis. CONCLUSIONS Neurotoxic snake bite is an independent predictor of mortality in snake bite patients. Currently used polyvalent ASV may be less effective in treating neurotoxic snake bite.
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Affiliation(s)
- Shraddha M Pore
- Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India
| | - Sunita J Ramanand
- Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India
| | - Praveenkumar T Patil
- Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India
| | - Alka D Gore
- Department of Preventive and Social Medicine, BVDU Medical College, Sangli, Maharashtra, India
| | - Mayur P Pawar
- Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India
| | - Smita L Gaidhankar
- Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India
| | - Ravi R Ghanghas
- Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India
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Farooqui JM, Mukherjee BB, Manjhi SNM, Farooqui AAJ, Datir S. Incidence of fatal snake bite in Loni, Maharashtra: An autopsy based retrospective study (2004-2014). J Forensic Leg Med 2016; 39:61-4. [PMID: 26854851 DOI: 10.1016/j.jflm.2016.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/09/2015] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
Snake bite is a major public health problem specially in a rural region where agricultural work is the major source of employment. A retrospective study was undertaken of all cases of deaths due to snake bite autopsied at the Mortuary of Pravara Rural Hospital, Loni a rural area in Western Maharashtra over a period of 10 years from January 2004 to December 2014. Data of the study was gathered from autopsy reports and hospital records. The cases represented approximately 2.13% (54) of the total 2539 medico legal autopsies conducted during the study period. Most of the deaths (42.60%) occurred in the age group of 11-30 years and both males and females were affected in almost equal proportions. There was a marked increase in the number of cases in monsoon season (59.26%). The lower extremity was the most frequently involved site of bite (62.96%). Snakes were identified in 43 cases (79.63%) and among the identified cases the most common culprit was Viper amounting to 29.63% of cases followed by Krait causing 24.07% of the deaths. The findings in our study reflects the necessity of educating the rural community regarding the hazards of snake bite, importance of early medical attention and to avoid wasting vital time being engaged by traditional healers.
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Affiliation(s)
- Jamebaseer M Farooqui
- Department of Forensic Medicine & Toxicology, Rural Medical College of Pravara Institute of Medical Sciences, A/P Loni Bk, Tal. Rahata, Dist. Ahmednagar, Maharashtra 413736, India.
| | - Bimbisar B Mukherjee
- Department of Forensic Medicine & Toxicology, Rural Medical College of Pravara Institute of Medical Sciences, A/P Loni Bk, Tal. Rahata, Dist. Ahmednagar, Maharashtra 413736, India.
| | - Shiv Narayan M Manjhi
- Department of Forensic Medicine & Toxicology, Rural Medical College of Pravara Institute of Medical Sciences, A/P Loni Bk, Tal. Rahata, Dist. Ahmednagar, Maharashtra 413736, India.
| | - Anjum Ara J Farooqui
- Department of Oral Medicine & Radiology, Rural Dental College of Pravara Institute of Medical Sciences, A/P Loni Bk, Tal. Rahata, Dist. Ahmednagar, Maharashtra 413736, India.
| | - Sandesh Datir
- Department of Forensic Medicine & Toxicology, Dr D.Y. Patil Medical College, Hospital & Research Centre, Pune, Maharashtra, India.
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Abstract
Snake bite envenomations are common in rural areas and the incidence peaks during monsoons in India. Prominent venomous species have been traditionally labeled as the ‘big four’ that includes Cobra, Krait, Russel's viper and Saw scaled viper. Systematic attempts for identification and classification of prevalent snakes in various states of India are missing till now and there is no concrete data on this aspect. The published literature however shows that some species of snakes are more prevalent in a particular region than the other parts of India e.g. Saw scaled vipers in Rajasthan. We reviewed the published literature from various parts of India and found that there is a North-South divide in the snake bite profile from India. Neurotoxic envenomations are significantly higher in North India compared to South India where Hematotoxic envenomations are prevalent. Russel's viper causes local necrosis, gangrene and compartment syndrome. These manifestations have never been reported in North Indian snake bite profile in the published literature. Early morning neuroparalysis caused by Krait is a common problem in North India leading to high mortality after snake bite. This review presents supporting evidence for the North-South divide and proposes a way forward in formulation and revision of guidelines for snake bite in India.
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Affiliation(s)
- Vivek Chauhan
- Department of Medicine, Dr. RPGMC, Kangra, Tanda, Himachal Pradesh, India
| | - Suman Thakur
- Department of Microbiology, Dr. RPGMC, Kangra, Tanda, Himachal Pradesh, India
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Mukhopadhyay P, Mishra R, Mukherjee D, Mishra R, Kar M. Snakebite mediated acute kidney injury, prognostic predictors, oxidative and carbonyl stress: A prospective study. Indian J Nephrol 2016; 26:427-433. [PMID: 27942175 PMCID: PMC5131382 DOI: 10.4103/0971-4065.175987] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Snake bite is an occupational hazard in India and important preventable cause of acute kidney injury (AKI). This study was done to estimate the magnitude of snakebite-induced AKI (SAKI) who required renal replacement therapy, prognostic predictors, and final outcome, and to measure the oxidative and carbonyl stress (CS) level in SAKI patient who underwent hemodialysis (HD). All SAKI patients dialyzed between April 2010 and July 2011 in NRS Medical College were included. Demographical, clinical, and biochemical data were analyzed, and patients are followed to discharge or death. Oxidative and CS markers (advanced oxidation protein product [AOPP], advanced glycation end product, pentosidine, dityrosine, thioberbituric acid reactive substance, and methylglyoxal [MG]) were measured in 48 SAKI patient requiring HD. About 155 SAKI patients (M: F 2.2:1) received HD. Of them. The age was 36.2 (range 4–74) years. The most common site of the bite was lower limb (88.7%). Oliguria and bleeding manifestation were the common presentation. Hypotension was found in 52 (33.5%) cases, cellulitis and inflammation were found in about 63%. Mean creatinine was 4.56 ± 0.24 mg/dl. About 42 (27.1%) had disseminated intravascular coagulation (DIC). 36 (78.2%) had cellulites, 24 (52.2%) had hypotension or shock at initial presentation (P < 0.05), bleeding manifestation was found in 37 (80.4%), and 22 (47.8%) had DIC (P < 0.05). Forty-six (29.7%) patient died. DIC and hypotension/shock at initial presentation came out as an independent predictor of death. Among all markers measured for oxidative and CS (n = 48) AOPP and MG came out as an independent predictor (P < 0.05) of adverse outcome. Hypotension, DIC, AOPP, and MG were a poor prognostic marker in SAKI patients requiring dialysis.
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Affiliation(s)
- P Mukhopadhyay
- Department of Nephrology, NRS Medical College and Hospital, Kolkata, West Bengal, India
| | - R Mishra
- Department of Physiology, Ananda Mohan College, University of Calcutta, Kolkata, West Bengal, India
| | - D Mukherjee
- Department of Physiology, University of Calcutta, Kolkata, West Bengal, India
| | - R Mishra
- Department of Physiology, University of Calcutta, Kolkata, West Bengal, India
| | - M Kar
- Department of Biochemistry, NRS Medical College and Hospital, Kolkata, West Bengal, India
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Paulis MG, Faheem AL. Homicidal Snake Bite in Children. J Forensic Sci 2015; 61:559-561. [DOI: 10.1111/1556-4029.12997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/23/2015] [Accepted: 05/10/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Melad G. Paulis
- Forensic Medicine and Clinical Toxicology Department; Faculty of Medicine; Minia University; Egypt
| | - Ayman L. Faheem
- Egyptian Forensic Medicine Authority; Minia Office of Forensic Medicine; Minia Egypt
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Gopi K, Renu K, Sannanaik Vishwanath B, Jayaraman G. Protective effect of Euphorbia hirta and its components against snake venom induced lethality. JOURNAL OF ETHNOPHARMACOLOGY 2015; 165:180-190. [PMID: 25727964 DOI: 10.1016/j.jep.2015.02.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/22/2015] [Accepted: 02/18/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Despite the use of snake anti-venom therapy, herbal medicine is still in practice to treat snakebites. Euphorbia hirta is traditionally used as antidote for snakebites and also for numerous other ailments. However, the scientific evidence for its anti-snake venom property is still lacking. MATERIALS AND METHODS Methanolic extract of E. hirta was evaluated for anti-venom activity under in vitro and ex vivo conditions. Histopathological changes in the vital organs of the mice were also monitored. UHPLC-SRM/MS was used to estimate the phenolic constituents whereas GC-MS analysis was performed to analyze the volatile metabolites present. The major compound was further evaluated for its contribution to the overall inhibitory potential of the extract. RESULTS Methanolic extract of E. hirta completely inhibited the venom enzymes under in vitro and reduced the edema ratio. The extract increased the survival time (>24h) of mice which was further evidenced by histopathological analysis of vital organs. Phytochemical analysis revealed higher content of phenolic (144 mg/g extract) compounds in the extract. UHPLC-SRM/MS demonstrated that ellagic acid, gallic acid and quinic acid are the major phenolics whereas GC-MS analysis revealed pyrogallol as the major constituent (60.07%) among the volatile components of the extract. It was also shown that pyrogallol has the ability to differentially inhibit venom protease but not phospholipase A2. CONCLUSION The present study confirmed that E. hirta methanolic extract was able to completely inhibit Naja naja venom induced toxicity under in vitro as well as ex vivo conditions, thus providing scientific evidence to its traditional use.
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Affiliation(s)
- Kadiyala Gopi
- School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India
| | - Kadali Renu
- School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India
| | | | - Gurunathan Jayaraman
- School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu 632014, India.
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Abstract
This review is on the pulmonary complications of snakebites, which can have fatal consequences. We identified three common themes as reported in the literature regarding envenomation: generalized neuromuscular paralysis affecting airway and respiratory muscles, pulmonary edema, and pulmonary hemorrhages or thrombosis due to coagulopathy. Respiratory paralysis and pulmonary edema can be due to either elapid or viper bites, whereas pulmonary complications of coagulopathy are exclusively reported with viper bites. The evidence for each complication, timeline of appearance, response to treatment, and details of pathophysiology are discussed.
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Affiliation(s)
- Ariaranee Gnanathasan
- From the The Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Chaturaka Rodrigo
- From the The Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Biswas D, Yadav K, Borkakoty B, Mahanta J, Bansal PG, Toteja GS, Suman R, Gautam P, Sharma N, Sharma M, Choudhary S. Research Letters. Indian Pediatr 2015; 51:931-2. [DOI: 10.1007/s13312-014-0533-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Epidemiological profile and management of snakebite cases – A cross sectional study from Himachal Pradesh, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2015. [DOI: 10.1016/j.cegh.2015.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Thapar R, Darshan BB, Unnikrishnan B, Mithra P, Kumar N, Kulkarni V, Holla R, Kumar A, Kanchan T. Clinico-Epidemiological Profile of Snakebite Cases Admitted in a Tertiary Care Centre in South India: A 5 Years Study. Toxicol Int 2015; 22:66-70. [PMID: 26862263 PMCID: PMC4721179 DOI: 10.4103/0971-6580.172260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study was conducted to assess the clinic-epidemiological profile of snakebite cases admitted at a Tertiary Care Centre in South India. MATERIALS AND METHODS A record based retrospective study was carried out at Kasturbha Medical College affiliated hospitals in Mangalore. All the snakebite cases admitted to the hospitals from January 2007 to December 2011 were included in the study. Data were collected using a pretested semi-structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS version 11.5). The results are expressed as percentages. RESULTS The study included 198 cases of snakebite victims. The majority of the cases were males (68.2%). The mean age of the study population was 34.8 years. Maximum numbers of snakebite cases were reported during the month of September to December (47.9%). The peak time of snakebite was between 18.01 and 24.00 h which was reported in 40.5% of the cases. Lower extremities were the most common site of bite in more than three-fourth of the cases (80.9%). The most common symptoms were a pain (45.9%) and swelling (44.9%). The case fatality rate was observed to be 3.0%. CONCLUSION Snakebite still remains a major public health problem in this part of the world. Knowledge must be imparted regarding the prevention of snakebites through community health programs. Messages regarding prompt reporting of such cases and importance of effective treatment must be disseminated among people through mass media and role plays.
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Affiliation(s)
- Rekha Thapar
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - B B Darshan
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Nithin Kumar
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Vaman Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Ramesh Holla
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Avinash Kumar
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Tanuj Kanchan
- Department of Forensic Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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Dehghani R, Fathi B, Shahi MP, Jazayeri M. Ten years of snakebites in Iran. Toxicon 2014; 90:291-8. [DOI: 10.1016/j.toxicon.2014.08.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 11/28/2022]
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Kaushik R, Kharbanda PS, Bhalla A, Rajan R, Prabhakar S. Acute Flaccid paralysis in adults: Our experience. J Emerg Trauma Shock 2014; 7:149-54. [PMID: 25114422 PMCID: PMC4126112 DOI: 10.4103/0974-2700.136847] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 11/04/2013] [Indexed: 11/17/2022] Open
Abstract
Acute flaccid paralysis (AFP) is a complex clinical syndrome with a broad array of potential etiologies that vary with age. We present our experience of acute onset lower motor neuron paralysis.
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Affiliation(s)
- Rupesh Kaushik
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Parampreet S Kharbanda
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Roopa Rajan
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Sudesh Prabhakar
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
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Karunanayake RK, Dissanayake DMR, Karunanayake AL. A study of snake bite among children presenting to a paediatric ward in the main Teaching Hospital of North Central province of Sri Lanka. BMC Res Notes 2014; 7:482. [PMID: 25073710 PMCID: PMC4122051 DOI: 10.1186/1756-0500-7-482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 07/21/2014] [Indexed: 11/23/2022] Open
Abstract
Background Snake bite is a common problem in the North Central province of Sri Lanka. Common krait (Bungarus careuleus), Ceylon krait (Bungarus ceylonicus), Cobra (Naja naja), Russell’s viper (Daboia russelii), Saw-scaled viper (Echis carinatus) and Hump-nosed pit viper (Hypnale hypnale) are the six species of venomous land snakes in Sri Lanka. A significant number of adults and children are bitten by snakes every year. However, the majority of research studies done in Sri Lanka and other countries show adults bitten by snakes and studies describing children bitten by snakes are very sparse. Methods A descriptive cross sectional study was performed in the Teaching Hospital Anuradhapura in the North Central Province of Sri Lanka from May 2010 to 2011 May to describe the characteristics associated with cases of snake bite. Results There were 24 males and 20 females. The highest numbers of bites (48%) were in the range of ages 6-12 years. The majority of the bites occurred between 6 pm to 6 am (59%).The foot was the most common bitten site (48%). Out of all the venomous bites, the Hump-nosed pit viper (Hypnale hypnale) accounted for the highest number (44%) and Russell’s viper (Daboia ruselii) accounted for the second highest number (27%). A significant number of venomous bites occurred indoors while sleeping (22%). Antivenom serum was given to (39%) of venomous bites. Deaths occurred in (11%) of the venomous bites. Conclusions Hump-nosed pit viper (Hypnale hypnale) accounted for the highest number of venomous bites. Majority of the bites occurred between 6 pm and 6 am. Foot was the most common bitten site. A significant number of venomous bites occurred indoor while sleeping. Antivenom serum was given to a significant number of venomous bites. Educating the public on making their houses snake proof and using a torch when going out during night time will help in the prevention of getting bitten by snakes.
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Chaudhari TS, Patil TB, Paithankar MM, Gulhane RV, Patil MB. Predictors of mortality in patients of poisonous snake bite: Experience from a tertiary care hospital in Central India. Int J Crit Illn Inj Sci 2014; 4:101-7. [PMID: 25024937 PMCID: PMC4093960 DOI: 10.4103/2229-5151.134145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: This study was undertaken, to assess the clinical parameters in patients of poisonous snakebite, complications which occurred in them, their outcome and to evaluate various clinical predictors of mortality Materials and Methods: Four hundred and thirty-two patients of snake bite were admitted, of which 172 did not show any signs of envenomation and excluded. Two hundred and sixty patients had signs of local or systemic envenomation and included. Complete clinical examination, blood counts, kidney function tests, serum electrolytes, coagulation profile was done in all patients. All received tetanus toxoid and anti-snake venom (ASV). Appropriate supportive treatment was given. Clinical and laboratory parameters were compared between patients who were discharged (Group A) and those who expired (Group B). All data analysis was performed by using stata software version 10 [StataCorp LP, Texas, USA] and SPSS version 11 [SPSS Inc, Chicago, USA]. Results: Out of 260 patients, 58 died and 202 survived. Mean age was 34.97 ± 14.07 years. One hundred and eighty-six (71.5%) patients were from rural areas and 74 (28.5%) from urban. 63.4% of bites occurred during rainy season. One hundred and ninety-seven (75.8%) had bite on lower limb and 62 (23.8%) on upper limbs. All 260 patients (100%) had pain at site of bite, local swelling in 252 (96.9%) and blackening of skin, blebs in 18 (6.9%). Seventy-seven (29.6%) had bleeding tendencies. Ptosis was present in all the 65 patients with signs of neuroparalysis. Eighty (30.8%) patients had acute renal failure. The mean duration of stay in survivors was 7.50 + 4.13 days and in non-survivors it was 3.45 + 3.02 days. Out of 58 who died 18 (31%) patients, succumbed within 24 hrs. On multivariate analysis, significant predictors o mortality were bleeding tendency (P = 0.013), mean PTTK (sec) (P = 0.047), respiratory failure (P = 0.045), shock (P = 0.013), mean ASV dose (cc) (P < 0.001). Conclusions: Mortality in patients with snake bite can be predicted by simple variables like presence of bleeding tendencies, respiratory failure, and shock. These parameters can help the doctors at peripheral health centers to predict outcome, so that such high risk cases can be referred to higher centers for expertise management without wasting time.
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Affiliation(s)
| | - Tushar B Patil
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | | | - Ragini V Gulhane
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - Mangesh B Patil
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
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Law AD, Agrawal AK, Bhalla A. Indian common krait envenomation presenting as coma and hypertension: A case report and literature review. J Emerg Trauma Shock 2014; 7:126-8. [PMID: 24812460 PMCID: PMC4013730 DOI: 10.4103/0974-2700.130887] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 11/06/2013] [Indexed: 11/09/2022] Open
Abstract
Neuroparalytic snake bite is a common emergency situation encountered in India. Common krait (Bungarus caeruleus) and cobra (Naja naja) are important snakes causing neuroparalysis in North India. Despite severe neuroparalysis, patients who receive antivenin and ventilator support in time recover completely. Autonomic disturbances resulting in resting tachycardia, labile hypertension and sweating have been described in common krait envenomation. We present a case of common krait (B. caeruleus) envenomation presenting in the locked-in state and severe hypertension that remained in such a state for over 96 h before a gradual and sustained recovery.
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Affiliation(s)
- Arjun Datt Law
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | | | - Ashish Bhalla
- Department of Internal Medicine, PGIMER, Chandigarh, India
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Raina S, Raina S, Kaul R, Chander V, Jaryal A. Snakebite profile from a medical college in rural setting in the hills of Himachal Pradesh, India. Indian J Crit Care Med 2014; 18:134-8. [PMID: 24701062 PMCID: PMC3963195 DOI: 10.4103/0972-5229.128702] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective: The objective of the following study is to assess the clinical profiles and manifestations of snakebite patients in the rural hilly setting of Shivalik and the Lesser Himalayan region of Himachal Pradesh. Materials and Methods: A hospital record-based retrospective descriptive study was carried out that included details on demography, clinical profile, treatment and outcome among 200 patients over a period of 2 years. The data was analyzed using Chi-square test for comparison. Results: 142 (71%) patients were young (age group of 16-45 years) and the number of male patients was 118 (59%) and female patients were 82 (41%). All the cases recorded presented in the months of April to November. Not a single case was recorded from December to March. The most frequently bitten sites were the lower limbs particularly the feet. 86 (43%) of the patients presented without any features of envenomation. Neuroparalysis was the commonest presentation in 53 (46%) patients followed by hemotoxicity in 36 (31%) among symptomatic patients. Early morning neuroparalysis syndrome was the presentation in 26.4% patients. Allergic reactions in the form of early anaphylaxis were noted in 7% patients. Conclusion: Snake bite is a neglected tropical disease affecting poor villagers in rural areas. Future research focusing on understanding epidemiological determinants of snake bite is desired.
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Affiliation(s)
- Sujeet Raina
- Department of Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - Sunil Raina
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - Rashmi Kaul
- Department of Pathology, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - Vishav Chander
- Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - Ajay Jaryal
- Department of Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
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Gutiérrez JM, Burnouf T, Harrison RA, Calvete JJ, Kuch U, Warrell DA, Williams DJ. A multicomponent strategy to improve the availability of antivenom for treating snakebite envenoming. Bull World Health Organ 2014; 92:526-32. [PMID: 25110378 DOI: 10.2471/blt.13.132431] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 11/27/2022] Open
Abstract
Snakebite envenoming is a common but neglected public health problem, particularly in impoverished rural regions of sub-Saharan Africa, Asia and Latin America. The only validated treatment for this condition is passive immunotherapy with safe and effective animal-derived antivenoms. However, there is a long-lasting crisis in the availability of these life-saving medications, particularly in sub-Saharan Africa and parts of Asia. We herein advocate a multicomponent strategy to substantially improve the availability of safe and effective antivenoms at the global level. This strategy is based on: (i) preparing validated collections of representative venom pools from the most medically dangerous snakes in high-risk regions of the world; (ii) strengthening the capacity of national antivenom manufacturing and quality control laboratories and their regulatory authorities and establishing new facilities in developing countries through technology transfer, as an integral part of efforts to develop their biological products industry; (iii) getting established laboratories to generate antivenoms for various regions of the world; and (iv) getting governments and relevant organizations to give snakebite envenoming due recognition within national and international public health policy frameworks. These ways of making antivenom available should be complemented by actions to improve health information systems, the accessibility of antivenoms, the training of medical and nursing staff, and community-based education. Such a multicomponent strategy involving stakeholders on many levels could help consolidate sustainable improvements in antivenom availability worldwide.
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Affiliation(s)
- José María Gutiérrez
- Instituto Clodomiro Picado, Universidad de Costa Rica, San José 11501, Costa Rica
| | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan, China
| | - Robert A Harrison
- Alistair Reid Venom Research Unit, Liverpool School of Tropical Medicine, Liverpool, England
| | - Juan J Calvete
- Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas, Valencia, Spain
| | | | - David A Warrell
- John Radcliffe Hospital, University of Oxford, Oxford, England
| | - David J Williams
- Department of Pharmacology and Therapeutics, University of Melbourne, Parkville, Australia
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Dharod MV, Patil TB, Deshpande AS, Gulhane RV, Patil MB, Bansod YV. Clinical predictors of acute kidney injury following snake bite envenomation. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:594-9. [PMID: 24350071 PMCID: PMC3842700 DOI: 10.4103/1947-2714.120795] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Snake bite envenomation is a major public health concern in developing countries. Acute kidney injury (AKI) is as important cause of mortality in patients with vasculotoxic snake bite. Aims: This study was to evaluate the clinical profile of snake bite patients and to determine the predictors of developing AKI following snake bite. Materials and Methods: Two hundred and eighty-one patients with snake envenomation were included. Eighty-seven patients developed AKI (Group A) and 194 (Group B) did not. History, examination findings and investigations results were recorded and compared between the two groups. Results: In group A, 61 (70.11%) patients were male and in group B, 117 (60.30%) patients were male. Out of 281 patients, 232 had cellulitis, 113 had bleeding tendencies, 87 had oliguria, 76 had neuroparalysis, and 23 had hypotension at presentation. After multivariate analysis, bite to hospital time (P = 0.016), hypotension (P = 0.000), albuminuria (P = 0.000), bleeding time (P = 0.000), prothrombin time (P = 0.000), hemoglobin (P = 0.000) and total bilirubin (P = 0.010) were significant independent predictors of AKI. Conclusions: AKI developed in 30.96% of patients with snake bite, leading to mortality in 39.08% patients. Factors associated with AKI are bite to hospital time, hypotension, albuminuria, prolonged bleeding time, prolonged prothrombin time, low hemoglobin and a high total bilirubin.
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Affiliation(s)
- Mrudul V Dharod
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - Tushar B Patil
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - Archana S Deshpande
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - Ragini V Gulhane
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - Mangesh B Patil
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - Yogendra V Bansod
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
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Abstract
Snakebite is classified by the WHO as a neglected tropical disease. Envenoming is a significant public health problem in tropical and subtropical regions. Neurotoxicity is a key feature of some envenomings, and there are many unanswered questions regarding this manifestation. Acute neuromuscular weakness with respiratory involvement is the most clinically important neurotoxic effect. Data is limited on the many other acute neurotoxic manifestations, and especially delayed neurotoxicity. Symptom evolution and recovery, patterns of weakness, respiratory involvement, and response to antivenom and acetyl cholinesterase inhibitors are variable, and seem to depend on the snake species, type of neurotoxicity, and geographical variations. Recent data have challenged the traditional concepts of neurotoxicity in snake envenoming, and highlight the rich diversity of snake neurotoxins. A uniform system of classification of the pattern of neuromuscular weakness and models for predicting type of toxicity and development of respiratory weakness are still lacking, and would greatly aid clinical decision making and future research. This review attempts to update the reader on the current state of knowledge regarding this important issue.
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Affiliation(s)
- Udaya K. Ranawaka
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- * E-mail:
| | - David G. Lalloo
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Yates VM, Lebas E, Orpiay R, Bale BJ. Management of snakebites by the staff of a rural clinic: the impact of providing free antivenom in a nurse-led clinic in Meserani, Tanzania. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 104:439-48. [DOI: 10.1179/136485910x12743554760306] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Warrell DA, Gutiérrez JM, Calvete JJ, Williams D. New approaches & technologies of venomics to meet the challenge of human envenoming by snakebites in India. Indian J Med Res 2013; 138:38-59. [PMID: 24056555 PMCID: PMC3767246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The direct estimate of 46,000 snakebite deaths in India in 2005 (1 for every 2 HIV/AIDS deaths), based on verbal autopsies, renders unrealistic the total of only 47,000 snakebite deaths in the whole world in 2010, obtained indirectly as part of the "Global Burden of Disease 2010" study. Persistent underestimation of its true morbidity and mortality has made snakebite the most neglected of all the WHO's "neglected tropical diseases", downgrading its public health importance. Strategies to address this neglect should include the improvement of antivenom, the only specific antidote to envenoming. To accommodate increased understanding of geographical intraspecific variation in venom composition and the range of snake species that are medically important in India, the design of antivenoms (choice of venom sources and species coverage) should be reconsidered. Methods of preclinical and clinical testing should be improved. The relatively new science of venomics involves techniques and strategies for assessing the toxin composition of snake venoms directly through proteomics-centred approaches or indirectly via high-throughput venom gland transcriptomics and bioinformatic analysis. Antivenomics is translational venomics: a proteomics-based protocol to quantify the extent of cross-reactivity of antivenoms against homologous and heterologous venoms. These approaches could revolutionize the preclinical assessment of antivenom efficacy, leading to a new generation of antivenoms that are clinically more effective.
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Affiliation(s)
- David A. Warrell
- Global Snakebite Initiative, P.O. Box 193, Herston, Qld, 4029, Australia,Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK,Reprint requests: Prof. David A. Warrell, Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK e-mail:
| | - José María Gutiérrez
- Global Snakebite Initiative, P.O. Box 193, Herston, Qld, 4029, Australia,Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Juan J. Calvete
- Global Snakebite Initiative, P.O. Box 193, Herston, Qld, 4029, Australia,Laboratorio de Venómica y Proteinómíca Estructural, Instituto de Biomedicina de Valencia, CSIC, Jaime Roig 11, 46010 Valencia, Spain
| | - David Williams
- Global Snakebite Initiative, P.O. Box 193, Herston, Qld, 4029, Australia,Australian Venom Research Unit, Department of Pharmacology, University of Melbourne, Parkville, Vic, 3010. Australia,School of Medicine & Health Sciences, University of Papua New Guinea, Boroko, NCD, Papua New Guinea
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Jalali S, Padhi TR, Bansal R, Sahoo K, Basu S, Mathai A. Visual loss with inner retinal dysfunction, after snake bite: two case reports. Doc Ophthalmol 2013; 127:155-63. [PMID: 23686646 DOI: 10.1007/s10633-013-9390-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/13/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To report two cases of visual loss following snake bite. METHOD Retrospective review of medical records including history, examination finding, fundus details and investigation reports (visual field, electroretinogram, visual evoked potential and optical coherence tomogram) at two centers. RESULT Two cases of snake bite presented to us with reduction of vision at 1 and 3 months after the incident. The subnormal b wave and abnormal pattern electroretinography in one case pointed at inner retinal dysfunction and neurotoxicity as the cause of visual loss in an apparently normal-looking fundus. The electronegative b wave in the other gave us a clue that the optic atrophy was consecutive (secondary to inner retinal dysfunction due to central retinal artery occlusion). CONCLUSION When presented late, diagnosis of visual loss secondary to snake bite becomes difficult and puzzling due to the absence of classical findings. Electrophysiological tests in such cases give us important clue to reach at a definite diagnosis.
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Affiliation(s)
- Subhadra Jalali
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
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Saravu K, Somavarapu V, Shastry AB, Kumar R. Clinical profile, species-specific severity grading, and outcome determinants of snake envenomation: An Indian tertiary care hospital-based prospective study. Indian J Crit Care Med 2013; 16:187-92. [PMID: 23559724 PMCID: PMC3610449 DOI: 10.4103/0972-5229.106499] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: We undertook this study to assess the clinical profile and outcome determinants of different snake envenomation as well as to assign species-specific severity grade to different cases based on clinico – laboratory evidence scale. Materials and Methods: A prospective clinico – epidemiologic evaluation for outcome determinants of snakebite envenomation was carried out based on a clinico – laboratory severity grading scale, among 76 patients over a period of 2 years, in a tertiary care hospital in southern India. Results: Majority of patients were male agricultural workers (53.9%) followed by housewives (19.7%), and students (9.2%). Occurrence of viper snake envenomation with hemotoxic syndrome (73.68%) was highest followed by cobra and krait envenomation with neurotoxic (19.73%) and hemo – neurotoxic (5.3%) syndrome, respectively. On the contrary, maximum mortality and severity was seen in krait (60%) followed by cobra (13.33%) and viper (8.9%) envenomation. The average dose of anti-snake venom (ASV) administered varied from 9.83 (±7.22) to 20.25 (±4.92) vials throughout grade I to IV in all snake species envenomation. An increase in severity grade, ASV dose, and mortality were observed with the corresponding delay in ‘bite to needle time.’ Also, initial traditional treatments and krait species envenomation were significantly associated with higher grades of severity and mortality. Conclusion: There is an urgent need to spread awareness among the community for avoidance of traditional treatment and any delay in medical intervention in snakebite incidents.
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Affiliation(s)
- Kavitha Saravu
- Department of Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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