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Stephen S, Mohanty CR, Radhakrishnan RV, Issac A, Jacob J, Krishnan N, Vr V, Guru S, Muhammed Shaji I, Aggarwal A. Clinico-Epidemiological Profile, Trends, and Health-Related Outcomes of Snakebite Victims: A One-Year Prospective Study from Eastern India. Wilderness Environ Med 2024; 35:155-165. [PMID: 38634117 DOI: 10.1177/10806032241239628] [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: 04/19/2024]
Abstract
INTRODUCTION Snakebite envenomation is a significant life-threatening public health problem in Southeast Asia (SEA). In this region, India reported the largest number of snakebite deaths from 2000 to 2019 (1.2 million), with an average of 58,000 deaths yearly. METHODS This prospective observational study was carried out among snakebite victims at the emergency department (ED) of a tertiary care public sector hospital in eastern India. RESULTS A total of 145 cases of venomous snakebite were investigated. More than half (n = 81, 56%) of the snakebite victims were between 17 to 45 years. Most of the snakebite victims were male (68%) and were farmers (53%) by occupation. The majority of snakebites occurred during the daytime (76%) and while outdoors (67%). Most victims sustained a bite on the lower extremity (71%). The peak incidence of snakebites occurred from June to September (69%). Three-quarters of all patients were unaware of the required first aid measures following a snakebite. Among the 145 venomous snakebites, 48 were presumptively identified as the Indian cobra, 32 by the Indian krait, 56 by the Russel's viper, and 9 by saw-scaled viper. The mean duration from the snakebite to the onset of systemic effects in the Indian cobra was 52 ± 14.28 min, 66 ± 18.35 min in the Indian krait, 42 ± 13.47 min in Russel's viper, and 48 ± 16.38 min in saw-scaled viper. Respiratory failure was the commonly observed complication following an elapid envenomation. The mortality rate was 2.1% among the patients treated with antivenom. CONCLUSIONS Snakebite is considered an occupational hazard in India, commonly affecting the young population in their productive period. The peak incidence was during monsoon season, and the majority had neurotoxic envenomation following an elapid bite (55%) that contributed to the increased mortality and morbidity among young adults. Of the 145 patients, the majority (84%) recovered fully with treatment; 16% of the victims developed morbidity viz cellulitis, respiratory failure, acute renal failure, compartment syndrome, local tissue necrosis, intracerebral hemorrhage, and disseminated intravascular coagulation. Appropriate first aid measures and timely medical intervention can significantly improve the treatment outcome following snakebites.
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Affiliation(s)
- Shine Stephen
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | | | - Alwin Issac
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Jaison Jacob
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Nadiya Krishnan
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Vijay Vr
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Raebareli, India
| | - Satyabrata Guru
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Achala Aggarwal
- Department of Nursing Services, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Kaulgud RS, Hasan T, Vanti GL, Veeresh S, Uppar AP, Kurjogi MM. Snake Venom-specific Phospholipase A2: A Diagnostic Marker for the Management of Snakebite Cases. Indian J Crit Care Med 2022; 26:1259-1266. [PMID: 36755629 PMCID: PMC9886021 DOI: 10.5005/jp-journals-10071-24362] [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: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Snakebites are a common cause of morbidity and mortality, especially in tropical countries. Snakebites in any community are managed based on the clinical features and intravenous administration of antisnake venom (ASV). The administration of ASV is either deficient or given in excess based on clinical decisions and whole blood clotting test results. The present study is designed to analyze the level of snake venom component in the blood of snakebite in association with the clinical features. Patients and methods Blood samples were collected from the patients admitted to Karnataka Institute of Medical (KIMS) hospital with a history of snakebite considering the inclusion criteria. Serum was collected from the blood of snakebite patients before and after ASV and used to assess the level of venom-specific phospholipase A2 (PLA2) enzyme using the enzyme-linked immunosorbent assay (ELISA) method. Results Quantitative ELISA results revealed that the snake venom-specific PLA2 in the victim's blood was in the range of 0.3-1.27 mg/mL before the administration of ASV. However, the concentration of PLA2 after 24 hours of ASV administration was decreased in most of the patients. Further, it was observed that envenomation complications were directly proportional to the amount of snake venom-specific PLA2 found in the blood of the snakebite patient. Conclusion The study concludes that snake venom-specific PLA2 in the blood of snakebite patients could be used as a reliable venom marker, which helps in determination of appropriate ASV dosage in snakebite patients. How to cite this article Kaulgud RS, Hasan T, Vanti GL, Veeresh S, Uppar AP, Kurjogi MM. Snake Venom-specific Phospholipase A2: A Diagnostic Marker for the Management of Snakebite Cases. Indian J Crit Care Med 2022;26(12):1259-1266.
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Affiliation(s)
- Ram S Kaulgud
- Multi-Disciplinary Research Unit, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Tousif Hasan
- Department of General Medicine, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Gulamnabi L Vanti
- Multi-Disciplinary Research Unit, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - S Veeresh
- Multi-Disciplinary Research Unit, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Amruta P Uppar
- Multi-Disciplinary Research Unit, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - Mahantesh M Kurjogi
- Multi-Disciplinary Research Unit, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India,Mahantesh M Kurjogi, Multi-Disciplinary Research Unit, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India, e-mail:
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Gopalakrishnan M, Saurabh S, Sagar P, Bammigatti C, Dutta TK. A simple mortality risk prediction score for viper envenoming in India (VENOMS): A model development and validation study. PLoS Negl Trop Dis 2022; 16:e0010183. [PMID: 35192642 PMCID: PMC8896694 DOI: 10.1371/journal.pntd.0010183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/04/2022] [Accepted: 01/20/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Snakebite is a neglected problem with a high mortality in India. There are no simple clinical prognostic tools which can predict mortality in viper envenomings. We aimed to develop and validate a mortality-risk prediction score for patients of viper envenoming from Southern India. METHODS We used clinical predictors from a prospective cohort of 248 patients with syndromic diagnosis of viper envenoming and had a positive 20-minute whole blood clotting test (WBCT 20) from a tertiary-care hospital in Puducherry, India. We applied multivariable logistic regression with backward elimination approach. External validation of this score was done among 140 patients from the same centre and its performance was assessed with concordance statistic and calibration plots. FINDINGS The final model termed VENOMS from the term "Viper ENvenOming Mortality Score included 7 admission clinical parameters (recorded in the first 48 hours after bite): presence of overt bleeding manifestations, presence of capillary leak syndrome, haemoglobin <10 g/dL, bite to antivenom administration time > 6.5 h, systolic blood pressure < 100 mm Hg, urine output <20 mL/h in 24 h and female gender. The lowest possible VENOMS score of 0 predicted an in-hospital mortality risk of 0.06% while highest score of 12 predicted a mortality of 99.1%. The model had a concordance statistic of 0·86 (95% CI 0·79-0·94) in the validation cohort. Calibration plots indicated good agreement of predicted and observed outcomes. CONCLUSIONS The VENOMS score is a good predictor of the mortality in viper envenoming in southern India where Russell's viper envenoming burden is high. The score may have potential applications in triaging patients and guiding management after further validation.
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Affiliation(s)
- Maya Gopalakrishnan
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Suman Saurabh
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pramod Sagar
- Department of Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Chanaveerappa Bammigatti
- Department of Medicine, Jawaharlal Institute of Medical Education and Research, Puducherry, India
| | - Tarun Kumar Dutta
- Department of Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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Venom proteomic analysis of medically important Nigerian viper Echis ocellatus and Bitis arietans snake species. Biochem Biophys Rep 2021; 28:101164. [PMID: 34765747 PMCID: PMC8571701 DOI: 10.1016/j.bbrep.2021.101164] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
Snakebite envenoming remains a neglected tropical disease which poses severe health hazard, especially for the rural inhabitants in Africa. In Nigeria, vipers are responsible for the highest number of deaths. Hydrophilic interaction liquid chromatography coupled with LC-MS/MS was used to analyze the crude venoms of Echis ocellatus (Carpet viper) and Bitis arietans (Puff adder) in order to understand their venom proteomic identities. Results obtained revealed that gel-free proteomic analysis of the crude venoms led to the identification of 85 and 79 proteins, respectively. Seventy-eight (78) proteins were common between the two snake species with a 91.8% similarity score. The identified proteins belong to 18 protein families in E. ocellatus and 14 protein families in B. arietans. Serine proteases (22.31%) and metalloproteinases (21.06%) were the dominant proteins in the venom of B. arietans; while metalloproteinases (34.84%), phospholipase A2s (21.19%) and serine proteases (15.50%) represent the major toxins in the E. ocellatus venom. Other protein families such as three-finger toxins and cysteine-rich venom proteins were detected in low proportions. This study provides an insight into the venom proteomic analysis of the two Nigerian viper species, which could be useful in identifying the toxin families to be neutralized in case of envenomation. Venom proteomic of Nigeria's most medically important snakes is presented. SVMP, SVSP and PLA2 were the major toxin families in E. ocellatus and B. arietans. The venom proteomes of these vipers displayed 91.8% similarity in composition.
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Nduagubam OC, Chime OH, Ndu IK, Bisi-Onyemaechi A, Eke CB, Amadi OF, Igbokwe OO. Snakebite in children in Nigeria: A comparison of the first aid treatment measures with the world health organization's guidelines for management of snakebite in Africa. Ann Afr Med 2020; 19:182-187. [PMID: 32820730 PMCID: PMC7694701 DOI: 10.4103/aam.aam_38_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Snakebite and envenomation remains a public health problem with significant morbidity and mortality in children in developing countries. The World Health Organization (WHO) in 2010 developed guidelines for the prevention and management of snakebite in Africa. Aim The aim of this study was to compare the pattern of first aid treatment among children presenting with snakebite/envenomation with the 2010 WHO guideline for the prevention and clinical management of snakebite in Africa. Patients and Methods All children who presented with snakebite over a 7-year period in a teaching hospital in Enugu, Nigeria. The first aid treatment given to these children was obtained and was compared with the provisions of the WHO guideline for the prevention and clinical management of snakebite in Africa (2010). Data collected were analyzed using SPSS version 22. Results Five (71.4%) of the snakebites occurred in the rainy season and in the dark involving the lower limbs in 85.7% of cases. Six (87.5%) of the patients received one form of first aid before presentation to a health facility. None received first aid interventions in line with the WHO recommendation. Topical application of herbal concoctions to the site of the bite (37.5%) was the most common intervention. One (14.3%) of the children was promptly brought to the health facility following snakebite. The interval from bite to presentation to the health facility ranged from 1 to 12 h (median 5 h: 43 min). Conclusion Huge gaps still exist in the first aid treatment given to snakebite victims compared to the WHO guidelines.
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Affiliation(s)
| | - Onyinye H Chime
- Department of Community Medicine, Enugu State University College of Medicine, ESUT, Enugu, Enugu State, Nigeria
| | - Ikenna K Ndu
- Department of Paediatrics, Enugu State University College of Medicine, ESUT, Enugu, Enugu State, Nigeria
| | - A Bisi-Onyemaechi
- Department of Paediatrics, College of Medicine, University of Nigeria, Ituku/Ozalla, Enugu State, Nigeria
| | - Christopher B Eke
- Department of Paediatrics, College of Medicine, University of Nigeria, Ituku/Ozalla, Enugu State, Nigeria
| | - Ogechukwu F Amadi
- Department of Paediatrics, Enugu State University College of Medicine, ESUT, Enugu, Enugu State, Nigeria
| | - Obianuju O Igbokwe
- Department of Paediatrics, College of Medicine, University of Nigeria, Ituku/Ozalla, Enugu State, Nigeria
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Suraweera W, Warrell D, Whitaker R, Menon G, Rodrigues R, Fu SH, Begum R, Sati P, Piyasena K, Bhatia M, Brown P, Jha P. Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study. eLife 2020; 9:e54076. [PMID: 32633232 PMCID: PMC7340498 DOI: 10.7554/elife.54076] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/04/2020] [Indexed: 12/03/2022] Open
Abstract
The World Health Organization call to halve global snakebite deaths by 2030 will require substantial progress in India. We analyzed 2833 snakebite deaths from 611,483 verbal autopsies in the nationally representative Indian Million Death Study from 2001 to 2014, and conducted a systematic literature review from 2000 to 2019 covering 87,590 snakebites. We estimate that India had 1.2 million snakebite deaths (average 58,000/year) from 2000 to 2019. Nearly half occurred at ages 30-69 years and over a quarter in children < 15 years. Most occurred at home in the rural areas. About 70% occurred in eight higher burden states and half during the rainy season and at low altitude. The risk of an Indian dying from snakebite before age 70 is about 1 in 250, but notably higher in some areas. More crudely, we estimate 1.11-1.77 million bites in 2015, of which 70% showed symptoms of envenomation. Prevention and treatment strategies might substantially reduce snakebite mortality in India.
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Affiliation(s)
- Wilson Suraweera
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - David Warrell
- Nuffield Department of Clinical Medicine, University of OxfordOxfordUnited Kingdom
| | - Romulus Whitaker
- Centre for Herpetology/Madras Crocodile Bank, Vadanemmeli VillageChennaiIndia
| | - Geetha Menon
- Indian Council of Medical Research, Ansari NagarNew DelhiIndia
| | - Rashmi Rodrigues
- Department of Community Health, St. John's Medical College, St. John's National Academy of Health SciencesBangaloreIndia
| | - Sze Hang Fu
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Rehana Begum
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Prabha Sati
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Kapila Piyasena
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Mehak Bhatia
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
| | - Patrick Brown
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
- Department of Statistical Sciences, University of TorontoTorontoCanada
| | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto, and Dalla Lana School of Public Health, University of TorontoOntarioCanada
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Gajbhiye R, Khan S, Kokate P, Mashal I, Kharat S, Bodade S, Yadav A, Mahale S. Incidence & management practices of snakebite: A retrospective study at Sub-District Hospital, Dahanu, Maharashtra, India. Indian J Med Res 2019; 150:412-416. [PMID: 31823924 PMCID: PMC6902356 DOI: 10.4103/ijmr.ijmr_1148_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Indexed: 11/06/2022] Open
Abstract
This study was undertaken to know the incidence and management practices of snakebite envenomation at the First Referral Unit - Sub-District Hospital, Dahanu, Maharashtra, India. Retrospective analysis of snakebite case records (n=145) was carried out for one-year period (January to December 2014). The annual incidence of snakebite was 36 per 100,000 population with case fatality rate of 4.5 per cent. Venomous snakebites were 76 per cent and non-venomous snakebites were 24 per cent. Overall, snakebites were more common in males (52.4%) than females (47.6%). Majority of the snakebites (66%) were in the age group of 18-45 yr. Seasonal variation was observed with highest snakebites in monsoon (58%). Lower extremities were the most common site of bites (63%). Neurotoxic and vasculotoxic envenomation were reported in 19 and 27 per cent snakebite cases, respectively. Anti-snake venom (ASV) was administered at an average dose of 7.5±0.63 vials (range 2-40, median 6). There was no uniform protocol followed for ASV administration as per the National Snakebite Management Protocol of Government of India (2009).
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Affiliation(s)
- Rahul Gajbhiye
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
- Model Rural Health Research Unit, Department of Health Research, Ministry of Health & Family Welfare, Government of India, India
| | - Shagufta Khan
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Pratibha Kokate
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Iranna Mashal
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Sunita Kharat
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Sanjay Bodade
- Sub District Hospital, Dahanu, District Palghar, Public Health Department, Government of Maharashtra, India
| | - Arun Yadav
- Sub District Hospital, Dahanu, District Palghar, Public Health Department, Government of Maharashtra, India
| | - Smita Mahale
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
- Model Rural Health Research Unit, Department of Health Research, Ministry of Health & Family Welfare, Government of India, India
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Abd El-Aziz FEZA, El Shehaby DM, Elghazally SA, Hetta HF. Toxicological and epidemiological studies of scorpion sting cases and morphological characterization of scorpions ( Leiurusquin questriatus and Androctonus crassicauda) in Luxor, Egypt. Toxicol Rep 2019; 6:329-335. [PMID: 31049294 PMCID: PMC6479097 DOI: 10.1016/j.toxrep.2019.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/28/2019] [Accepted: 03/03/2019] [Indexed: 11/30/2022] Open
Abstract
Scorpion sting is still a threatening heath problem in developing countries as Egypt. Scorpion stings are common among children. Local reactions to scorpion stings were; pain at sting site was most frequent followed by redness and swelling. Systemic manifestations of were vomiting, headache, disturbed conscious level and abnormalities in ECG. Cardiac dysrhythmia was the main cause of death. Manifestations due to Leiurus quinquestriatus envenamation are more severe than that due to Androctonus crassicauda, while latent onset of manifestations in Androctonus crassicauda cases responsible for bad prognosis and high mortality.
Background and aim Scorpion envenomation is a common acute life threatening health problem in developing countries as Egypt. Scorpion venom is a complex structure composed of neurotoxic proteins, salts, acidic proteins, and organic compounds, thereby having of neurologic, cardiovascular, hematologic, and renal side effects, in addition to local effects such as redness, pain, burning, and swelling. Aims The study consisted of two parts to describe demographic characteristics, toxicological manifestations of scorpion sting cases in Luxor, Egypt and morphological characterization of the commonest scorpion species in the studied community for easy rapid identification of scorpion species by doctors from the patient history to provide better choices of management Materials & methods First part of the study include all cases of scorpion envenomation attending General Hospital of Esna, Luxor, Egypt during the period of scorpion activity 2017, demographic data was collected then cases were assessed for clinical manifestations, ECG, complications and deaths related to scorpion species. Second part: scorpions were collected from areas around patient housing for morphological description of their sense organs and venom apparatus by Scanning Electron Microscopy. Results A total of 110 cases of scorpion stings were reviewed, males 81 (72.9%) and females 30 (27.1%), with a mean age of 31.9 ± 17.9 years. Localized pain was the most frequent presenting complaint (89 80.2%), vomiting was the commonest clinical symptom (90.9%). All scorpion stings were due to the most endemic species in North Africa, Leiurusquinquestriatus & Androctonuscrassicauda. Death rate among cases was (5.5%) all were Abroug’s Grade III. Cardiac dysrhythmia and subsequent pulmonary edema were the commonest cause of death. Clinical manifestations were more sever in Leiurus quinquestriatus stings while death rate was more in Androctonus crassicauda stings. The morphological characterization of the sense organs (eyes, pedipalps, pectines& sensory setae) and venom apparatus of the scorpions L. quinquestriatus & A. crassicauda were described by Scanning Electron Microscopy. Conclusion Scorpion sting is an acute heath threating in Southern Egypt, Leiurus quinquestriatus & Androctonus crassicauda are most endemic scorpion species in Southern Egypt. More attention for scorpion envenomation in such subtropical hyper desert localities is required to eradicate toxic scorpion species and prevent possible causes of deaths.
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Affiliation(s)
| | - Doaa M El Shehaby
- Department of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Assiut University, Egypt
| | - Shimaa A Elghazally
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Egypt
| | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Egypt.,Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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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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Gopalakrishnan M, Vinod KV, Dutta TK, Shaha KK, Sridhar MG, Saurabh S. Exploring circulatory shock and mortality in viper envenomation: a prospective observational study from India. QJM 2018; 111:799-806. [PMID: 30107433 DOI: 10.1093/qjmed/hcy175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Viper envenomation contributes to nearly 50% of snake-bite deaths in India, chiefly due to circulatory shock. The mechanisms leading to circulatory shock include bleeding, capillary leak syndrome (CLS) and myocardial depression. Pituitary-adrenal axis involvement in circulatory shock, though described, has not been fully elucidated. AIM To identify predictors of circulatory shock and mortality in viper envenomation and explore the role of pituitary-adrenal axis in circulatory shock. DESIGN Prospective hospital-based observational study. METHODS Once a syndromic diagnosis of viper envenomation was made, relevant clinical and laboratory data were collected. Serum cortisol was estimated in those with circulatory shock. Post-mortem examination of pituitary, kidneys and adrenals was performed. Adjusted odds-ratios were calculated for respective risk-factors for shock and mortality using multivariable logistic regression with backward elimination strategy. RESULTS Of 248 patients of viper envenomation treated at our hospital, circulatory shock was present in 19% and in-hospital mortality was 23%. CLS, circulatory shock, bleeding and requirement of > 20 vials of antivenom predicted mortality. Ischaemic and haemorrhagic necrosis of pituitary or adrenals was present in 51% of post-mortem specimens. Disseminated intravascular coagulation (DIC) and CLS were strong predictors of pituitary haemorrhage. CONCLUSION Predictors of mortality - bleeding, CLS and requirement of high antivenom doses are warning signs which can alert clinicians to patients who may have poor outcomes. Our study points to a definite role of pituitary-adrenal axis in circulatory shock supports the hypothesis that pituitary involvement in viper envenomation closely resembles Sheehan syndrome. The mechanism of pituitary involvement appears to be a result of increased susceptibility of the swollen gland secondary to CLS and micro thrombi deposition in DIC.
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Affiliation(s)
- M Gopalakrishnan
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry, India
| | - K V Vinod
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry, India
| | - T K Dutta
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry, India
| | - K K Shaha
- Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry, India
| | - M G Sridhar
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry, India
| | - S Saurabh
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry, India
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