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Hu S, Bao S, Shen Y, Tu M. The Epidemiology and Clinical Features of Deinagkistrodon acutus Envenomation: A Retrospective Study from a Medical Center in Hangzhou, Southeast China. Am J Trop Med Hyg 2024; 111:676-681. [PMID: 38955198 PMCID: PMC11376154 DOI: 10.4269/ajtmh.23-0680] [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: 10/02/2023] [Accepted: 03/25/2024] [Indexed: 07/04/2024] Open
Abstract
Deinagkistrodon acutus envenomation is one of the most common types of venomous snakebite in China and causes a series of envenomating effects on its victims. However, more specific information on the characteristics of D. acutus envenomation is rare in the English literature. Therefore, we aimed to give a detailed description of the epidemiological and clinical features of patients with D. acutus envenomation. Patients who were admitted with D. acutus envenomation between January 2018 and December 2021 were enrolled in this retrospective study. The data on demographics, clinical manifestations, laboratory features, management, and outcomes were collected. A total of 158 cases of D. acutus envenomation were enrolled. Men (n = 121; 76.6%) and rural populations (n = 133; 84.2%) were the high-risk groups, and most incidents (n = 141; 89.2%) happened between May and September. The specific effect was tissue necrosis at bite site, which occurred in 72 patients (45.6%). Other envenomation effects include extensive limb swelling, blistering, wound bleeding, and coagulopathy. In the envenomed patients, 155 (98.1%) received antivenom, 47 (29.7%) needed operations, 20 (12.7%) required intensive care, and one died. Deinagkistrodon acutus envenomation is a common snakebites emergency in Hangzhou area. A high rate of tissue necrosis at bite site and venom-induced consumption coagulopathy are the characteristics of D. acutus envenomation. Although the mortality rate is low, some patients still require intensive care.
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Affiliation(s)
- Sipin Hu
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuhua Bao
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuchen Shen
- Department of Dermatology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Mengyun Tu
- Department of Clinical Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
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Afroz A, Siddiquea BN, Chowdhury HA, Jackson TNW, Watt AD. Snakebite envenoming: A systematic review and meta-analysis of global morbidity and mortality. PLoS Negl Trop Dis 2024; 18:e0012080. [PMID: 38574167 PMCID: PMC11020954 DOI: 10.1371/journal.pntd.0012080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/16/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Snakebite envenoming represents a significant and often neglected public health challenge, particularly in rural communities across tropical and subtropical regions. An estimated 1.2-5.5 million people are envenomed by snakebites annually. More than 125,000 of these bites are fatal, and 3-4 times as many results in disability/disfigurement. Despite its prevalence, collecting accurate epidemiological data on snakebite is challenging. This systematic review and meta-analysis collates global epidemiology data on snakebite morbidity and mortality. METHODS Medline, Embase, Cochrane and CINAHL Plus databases were searched for articles published between 2001-2022. Pooled incidence and mortality were obtained using random effects modelling, heterogeneity (I2) was tested, and sensitivity analyses performed. Newcastle-Ottawa Scale assessed study quality. RESULTS Out of the four databases, 5,312 articles were found. After removing duplicates, 3,953 articles were screened by title and abstract and 65 articles containing information on snakebite epidemiology, encompassing 663,460 snakebites, were selected for analysis. The people most at risk for snakebite were men (59%), engaged in agricultural labour (27.5%), and residing in rural areas (66.7%). More than half (57%) of the reported bites resulted in envenoming. Incidents occurred frequently in the summer season (38.5%), during daytime (56.7%), and bites were most often to the lower limb (56.4%). Envenoming severity was frequently mild (46.7%), treated in hospital (68.3%), and was treated with anti-venom (64.7%). The pooled global incidence and mortality was 69.4 /100,000 population (95%CI: 36.8 to 101.9) and 0.33/100,000 population (95%CI, 0.14 to 0.52) per year, respectively. Stratified by continents, Asia had the highest incidence of 130.7/100,000 population (95%CI: 48.3 to 213.1) while Europe has the lowest with 0.7/100,000 population (95%CI: -0.2 to 1.5). The highest mortality was reported in Asia at 0.96/100,000 population (95% CI: 0.22 to 1.70), and Africa 0.44/100,000 population (95%CI: -0.03 to 0.84). Incidence was highest among inhabitants of lower-middle-income countries 132.7/100,000 population (95%CI: 55.4 to 209.9) while mortality was highest in low-income countries at 0.85/100,000 population (95% CI: -0.06 to 2.31). CONCLUSION Incidence and mortality rates noted here highlight the global impact of snakebite and underscore the critical need to address the burden of snakebite envenoming. It also reveals that while reported snakebite incidence was higher in lower-middle-income countries, the burden of mortality was greatest among inhabitants of low-income countries, again emphasising the need for greater efforts to tackle this neglected tropical disease.
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Affiliation(s)
- Afsana Afroz
- Australian Venom Research Unit, Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Bodrun Naher Siddiquea
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Hasina Akhter Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Timothy NW Jackson
- Australian Venom Research Unit, Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Andrew D. Watt
- Australian Venom Research Unit, Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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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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Gajbhiye RK, Munshi H, Bawaskar HS. National programme for prevention & control of snakebite in India: Key challenges & recommendations. Indian J Med Res 2023; 157:271-275. [PMID: 36926753 PMCID: PMC10438420 DOI: 10.4103/ijmr.ijmr_2424_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Indexed: 03/17/2023] Open
Affiliation(s)
- Rahul K. Gajbhiye
- Department of Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive & Child Health, Mumbai 400 012, Maharashtra, India
| | - Hrishikesh Munshi
- Department of Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive & Child Health, Mumbai 400 012, Maharashtra, India
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National snakebite project on capacity building of health system on prevention and management of snakebite envenoming including its complications in selected districts of Maharashtra and Odisha in India: A study protocol. PLoS One 2023; 18:e0281809. [PMID: 36800356 PMCID: PMC9937454 DOI: 10.1371/journal.pone.0281809] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Snakebite envenoming (SBE) is an acute, life-threatening emergency in tropical and subtropical countries. It is an occupational hazard and a major socioeconomic determinant. Limited awareness, superstitions, lack of trained health providers, poor utilization of anti-venom results in high mortality and morbidity. India is the snakebite capital of the world. Yet, information on awareness, knowledge, and perceptions about snakebite is limited. Data on capacity building of health systems and its potential impact is lacking. Recommended by the National Task Force on snakebite research in India, this protocol describes the National Snakebite Project aiming for capacity building of health systems on prevention and management of snakebite envenomation in Maharashtra and Odisha states. METHODS A cross-sectional, multi-centric study will be carried out in Shahapur, Aheri blocks of Maharashtra, and Khordha, Kasipur blocks of Odisha. The study has five phases: Phase I involves the collection of retrospective baseline data of snakebites, facility surveys, and community focus group discussions (FGDs). Phase II involves developing and implementing educational intervention programs for the community. Phase III will assess the knowledge and practices of the healthcare providers on snakebite management followed by their training in Phase IV. Phase V will evaluate the impact of the interventions on the community and healthcare system through FGDs and comparison of prospective and baseline data. DISCUSSION The National Snakebite Project will use a multi-sectoral approach to reduce the burden of SBE. It intends to contribute to community empowerment and capacity building of the public healthcare system on the prevention and management of SBE. The results could be useful for upscaling to other Indian states, South Asia and other tropical countries. The findings of the study will provide critical regional inputs for the revision of the National Snakebite Treatment protocol. TRIAL REGISTRATION Registered under the Clinical Trials Registry India no. CTRI/2021/11/038137.
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Kakkar B, Mallhi RS, Philip J. Type I ABO discrepancy due to missing antibody attributable to anti-snake venom in two patients: a rare presentation. Transfus Apher Sci 2022; 61:103437. [DOI: 10.1016/j.transci.2022.103437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
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Savu AN, Schoenbrunner AR, Politi R, Janis JE. Practical Review of the Management of Animal Bites. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3778. [PMID: 34522565 PMCID: PMC8432645 DOI: 10.1097/gox.0000000000003778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Abstract
Animal bites are common worldwide. Due to the plethora of animals, there are diverse pathogens with specific associated risks and treatment algorithms. It is crucial to understand these to develop and execute appropriate management plans. This practical review was designed to amalgamate the most common bites worldwide and synthesize data to help guide treatment plans. METHODS A PubMed literature search was performed focusing on the major animal bites. High-level studies were preferred and analyzed but lower-level studies were also used if high-level studies did not exist. RESULTS The tables presented in this article cover the pertinent information regarding the incidence, common presentation, initial treatment, and potential complications associated with bites from dogs, cats, horses, rodents, snakes, marine life, and spiders. Many of the pathogens associated with the bites are treatable with various and somewhat common antimicrobials, though some are less easy to access. Basic irrigation, debridement, and wound culture are common to almost every animal and should be the first step in treatment. CONCLUSIONS Based on the current studies, the most important factor in treating animal bites is timely presentation to a medical facility and/or physician. It is critical that the offending animal be accurately identified to help guide medical and surgical algorithms, including specific antimicrobial treatment guided by the most commonly presenting pathogens specific to certain animals.
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Affiliation(s)
- Andrei N. Savu
- From the Ohio State College of Medicine, The Ohio State University, Columbus, Ohio
| | - Anna R. Schoenbrunner
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| | - Rachel Politi
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
| | - Jeffrey E. Janis
- The University of Virginia School of Medicine, The University of Virginia, Charlottesville, Va
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Perceptions, awareness on snakebite envenoming among the tribal community and health care providers of Dahanu block, Palghar District in Maharashtra, India. PLoS One 2021; 16:e0255657. [PMID: 34351997 PMCID: PMC8341635 DOI: 10.1371/journal.pone.0255657] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/22/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION India has remarkably the highest number of snakebite cases contributing to nearly 50% of the global snakebite deaths. Despite this fact, there is limited knowledge and awareness regarding the management practices for snakebite in the Indian population. The study aimed to explore the knowledge, awareness, and perception of snakes and snakebites, first aid, and treatment amongst the community and the frontline health workers in a tribal block of Dahanu, Maharashtra, India. METHODS A cross-sectional study was carried out from June 2016 to October 2018 in the Dahanu Block, Maharashtra. Perceptions, knowledge, awareness, and first-aid practices on the snakebites among the community were studied through focus group discussions (FGDs). Semi-structured questionnaires were used to assess the knowledge, awareness, and experience of the traditional faith healers, snake rescuers, frontline health workers on the snakebites and their management. A facility check survey was conducted using pre-tested questionnaires for different levels of the government health care facilities. RESULTS Most of the tribal community was aware of the commonly found snakes and their hiding places. However, there was inadequate knowledge on the identification and classification of venomous snakes. Belief in a snake god, the perception that snakes will not come out during thunderstorms, change in taste sensation, the ability of tamarind seeds or magnet to reduce the venom effect were some of the superstitions reported by the tribal community. The application of a harmful method (Tourniquet) as the first aid for snakebite was practiced by the tribal community. They preferred herbal medicines and visiting the traditional faith healers before shifting the patient to the government health facility. The knowledge on the ability to identify venomous snakebites and anti-venom was significantly higher amongst nurses and accredited social health activists (ASHAs) than auxiliary nurse midwives (ANMs) and multi-purpose workers (MPWs) (p < 0.05). None of the traditional faith healers; but nearly 60% of snake rescuers were aware of anti-venom. Fifty percent of the medical officers in Dahanu block did not have correct knowledge about the Krait bite symptoms, and renal complications due to the Russell viper bite. CONCLUSIONS Inappropriate perception, inadequate awareness, and knowledge about snakes and snakebites may predispose the tribal community to increased risks of venomous snakebites. Unproven and harmful methods for snakebite treatment practiced by the community and traditional faith healers could be dangerous leading to high mortality. Therefore, a multi-sectoral approach of community awareness, mapping of vulnerable populations, capacity building of health care facility, empowerment of health care workers (HCWs) could be useful for reducing the mortality and morbidity due to snakebite envenoming in India.
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Abdeldayem A, Alanazi AA, Aljabri JN, Abid I. Challenges in the Management of an Echis coloratus Adult Snakebite Victim at a Tertiary Care Hospital: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931532. [PMID: 34103465 PMCID: PMC8197442 DOI: 10.12659/ajcr.931532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patient: Male, 18-year-old Final Diagnosis: Snakebite envenomation Symptoms: Coagulopathy Medication:— Clinical Procedure: Anti snake venom Specialty: General and Internal Medicine • Toxicology • Tropical Medicine
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Affiliation(s)
- Ahmed Abdeldayem
- In-Charge Drug and Poison Information Center, Prince Mohamed Bin Abdulaziz Hospital, Al Madina Al Monawara, Ministry of the National Guard Health Affairs, Al Madinah Al Monawara, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Alhanouf Ayed Alanazi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Internal Medicine Department, Prince Mohamed Bin Abdulaziz Hospital, Al Madina Al Monawara, Ministry of the National Guard Health Affairs, Al Madinah Al Monawara, Saudi Arabia
| | - Jawaher N Aljabri
- Internal Medicine Department, National guard health Affairs, Al Madinah Al Monawara, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ijaz Abid
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Internal Medicine Department, Prince Mohamed Bin Abdulaziz Hospital, Al Madina Al Monawara, Ministry of the National Guard Health Affairs, Al Madinah Al Monawara, Saudi Arabia
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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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Maity S, Chakraborty S, Banerjee P, Hazra R, Banerjee S, Sarkar N. A retrospective study on snakebite and its outcome from a referral-cum-teaching hospital of Kolkata, India. SAUDI JOURNAL FOR HEALTH SCIENCES 2020. [DOI: 10.4103/sjhs.sjhs_81_20] [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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