Bite Area Research Articles

Plastic strip strtetching with non-symmetric conditions in bite areas

Plastic strip strtetching with non-symmetric conditions in bite areas

Knowledge & Practice Regarding Animal Bite among Bite Victims Attending OPD Services in Karukachal (Tamil Nadu)

An animal bite is an injury caused by the mouth and teeth of an animal including humans. The present study was conducted in 2023 with the objective to assess the knowledge and practice regarding animal bite among bite victims attending OPD services of CHC, Karukachal. A descriptive research design & convenient sampling technique were used to conduct the study among 50 animal bite victims attending OPD services of CHC, Karukachal. The data were collected using self-structured knowledge and practice questionnaire. The data were analysed by using descriptive statistics. The results showed that most of the samples (84%) had average knowledge regarding animal bite. Also, 90 percent of samples cleaned the area of animal bite using soap and water; 50 percent cleaned the area thoroughly for 15 minutes, 76 percent of samples kept the suspected animal under observation. Twenty-six percent applied antiseptic solution or creams to the affected area, 76 percent consulted the doctor at the day of bite itself. All the samples were got vaccinated against rabies after animal bite. The study concluded that improved community awareness regarding animal bite and its management is required to fight against rabies.

A clinical case series of Rickettsia spp. from southern Türkiye

Rickettsial infections should be considered in the presence of a maculopapular rash, especially in the endemic area with a history of tick bite. In this study, Rickettsia spp. infections of three cases will be mentioned. Three cases with positive Rickettsia spp immunofluorescent antibody serology were included in the study. Case-1 was a 17-year-old male patient, who had a history of tick bite one week before the admission was admitted with chest pain. He had tachycardia and a "tache noir" rash with a necrotic center in the area of the tick bite. Laboratory parameters showed lymphopenia, cardiac enzymes elevation. The patient’s serelogy of Rickettsia conorii IgM was 1/192 titer positive and IgG was negative. He hospitalized as acute Mediterranean Spotted Fever myocarditis. He recovered with doxycycline treatment. Case-2 was a nine-month-old girl presented with fever, rash and lymphadenomegaly on left axilla two weeks after the tick bite of her left arm. The rash was localized to the arm. R. slovaca and R. aeschlimannii serologies were detected 1/40 titer positive. After ciprofloxacin treatment her symptoms had dissapeared. Case-3 was a seven-year-old girl presented with fever reaching 39ºC for five days, myalgia and rash all over her body. She had scratched the tick from the scalp five days before the admission. Rickettsia conorii IgM serology was 1/768, IgG was 1/640 titer positive. She recovered after doxycycline treatment. Rickettsia spp. infections can lead to infections like myocarditis or the spotted fever group Rickettsiosis diseases. Complications can be prevented with early diagnosis and treatment.

Neuromuscular and occlusion analysis to evaluate the efficacy of three splints on patients with bruxism

ObjectiveOcclusal splints are always applied on individuals with bruxism to reduce tooth wear and relieve orofacial symptoms such as myofascial pain. The stomatognathic system is mainly composed of tooth, occlusion, masticatory muscles, and temporomandibular joint. The occlusion and masticatory muscles function are regarded as the important parameters for evaluating the stomatognathic system state objectively. However, the effects of occlusal splints on individuals with bruxism is rarely elucidated from accurate neuromuscular analysis and occlusion evaluation. The aim of the present study was to estimate the effects of three different splints (two clinically common full coverage occlusal splint and an modified anterior splint) on subjects with bruxism using K7-J5 neuromuscular analysis system and Dental Prescale II (DP2) to evaluate occlusion.MethodsSixteen subjects claimed to be suffering from nocturnal bruxism,with complete dentition and stable occlusal relationship, were selected for study.The intermaxillary space and the baselines of EMG-activity of the anterior temporalis and masseter were recorded for all the subjects. The participants was treated with three different splints, and outcomes were estimated by comfort index, occlusion and surface electromyography of anterior temporalis and masseter.ResultsAt teeth clenched position, EMG data were significantly lower in the participants with use of modified anterior splint than with hard, soft occlusal splint or without splint (p < 0.05). The maximum bite force and bite area occur in subjects without use of splint, while the minimal occur in subjects with use of modified anterior splint. Intermaxillary space increased and masticatory muscles presented significant reduction of EMG data at rest position as a result of J5 (p < 0.05).ConclusionModified anterior splint seems to be more comfortable and effective in reducing occlusion force and electromyographic activity of anterior temporalis and masseter for subjects with bruxism.

Epidemiological characteristics, seasonality, trends of dog bite injuries, and relationship with meteorological data.

Animal bites are among the most critical in public health problems. Dogs are the leading cause of bite injuries. The study aimed to investigate the epidemiology and clinical features of dog bite cases admitted to an emergency department, as well as their temporal trends, seasonality, and tr relationship with meteorological data. Study data comprised eight years (2012-2019) emergency room records of a tertiary center. Demographic characteristics of the cases, bite anatomical area, treatment applied, hospitalization, and death rates were determined. The incidence rates and distribution of meteorological data by years were examined using ANOVA and Kruskal Wallis tests. Seasonality and temporal trends were investigated for incidence rates using the additive decomposition technique. The temporal relationship of incidence rates with meteorological data was evaluated using the Autoregressive Distributed Delayed Boundary Test. Causality verification was perfoirmed using the Granger test. Dog bite cases consisted of 1,335 records of partients with a mean age of 26.6±0.2 years. Bite cases were most common in the 20-44 age group (44.7%), males (76.4%), and lower extremities (48.2%). The frequency of hospitalization was 4.1%. Annual incidence rates ranged from 52.7-49.9/100,000, with a non-significant increasing trend. The incidence of bites had two peaks, in June and August. A co-integration relationship was observed between incidence rates and air temperature and humidity levels (p<0.001). Effective implementation of prevention programmes is needed for high-risk demographic groups. In addition, a national monitoring and reporting system could evaluate the effectiveness of any prevention programme and reduce the incedence of dog bites.

Selective sensory nerve blocks for effective pain management in the emergency department for a term pregnant cobra snake envenomation patient.

Sir, Snake bites with envenomation are a rare life-threatening emergency during pregnancy.[1] We report a case of a young full-term parturient who reported intense localized pain at the cobra (Naza Naza) bite site which was managed successfully by selective sensory nerve blocks. She subsequently underwent a caesarean section under spinal anaesthesia and had an uneventful post-partum course. A 26-year-old eight month pregnant patient presented to the emergency department (ED) post-cobra bite. The patient was taken to a local hospital within 30 min of the event. The bite mark was present on the right foot near the 4th toe [Figure 1]. There was minimal localized swelling but intense pain in the bite area. She had an episode of vomiting 45 min post-snake bite (suggesting the onset of systemic symptoms) and was administered 10 vials of anti-snake venom and referred to our tertiary care set-up.Figure 1: Distribution of superficial peroneal nerve (a); Probe placement for USG-guided block (b); USG image showing the superficial peroneal nerve (c); Snake bite mark on foot of the patient (d)When she presented to our ED 3h post-bite, the swelling had increased considerably and 10 more vials of anti-snake venom were infused. The investigations revealed leucocytosis with mild thrombocytopenia and anaemia. Local site pain was unbearable even after intravenous paracetamol and diclofenac. A superficial peroneal nerve and sural nerve blocks to cover the dorsolateral aspect of the foot was planned. The nerves were localized using a linear transducer (8–13 MHz) and a 3.5 ml of 0.75% ropivacaine was deposited. [Figures 1 and 2] Within 5 mins, the numeric rating scale (NRS) fall to 2 from the initial score of 10. At 10h, the patient reported an NRS score of 6, and the same blocks were repeated and effective pain relief was reported. The patient underwent a caesarean section under spinal anaesthesia at 18h post-admission given foetal distress. The baby was kept on nasal continuous positive airway pressure for 18h in view of respiratory distress and both of them were discharged in stable condition on the 3rd day of admission.Figure 2: Distribution of sural nerve (a); Probe placement for USG-guided block (b); USG image showing the sural nerve (c)Snake bites are rare in pregnancy but maternal mortality and foetal loss remain high.[1] An early presentation and rapidity of treatment with anti-snake venom probably led to a good outcome in this case. Acute localized moderate-to-severe pain is often documented as the first sign of a venomous snake bite (VSB).[2,3] The presynaptic and postsynaptic neurotoxins may directly interact with the nerve endings or indirectly cause severe pain secondary to ischemia due to local oedema.[1] Antivenom treatment fails to alleviate the local pain which may last for 48–72 h.[3] Weak opioids such as tramadol or paracetamol often provide inadequate analgesia.[4] Systemic opioids and non-steroidal anti-inflammatory drugs may be harmful to the foetus in term pregnancy. Furthermore, opioids can increase the risk of respiratory depression in neurotoxic envenomation cases as seen in cobra bite.[4] Untreated pain can have adverse consequences on foeto-maternal circulation.[5] In our case, the patient had intense pain with an NRS of 10 despite analgesics and responded well to nerve blocks. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The Effect of Fetuin-A and Other Laboratory Paremeters on Prognosis and Mortality in Crimean-Congo Hemorrhagic Fever.

Crimean-Congo Hemorrhagic Fever (CCHF) is a disease with high morbidity and mortality, which is an important health problem in the world. Therefore, we aimed to evaluate the effects of plasma fetuin-A (FA) level, which is a new parameter in terms of prognosis and mortality of CCHF. A total of 87 patients were included who presented to the Emergency Department, Bağcılar Training and Research Hospital, İstanbul, Turkey with the diagnosis of CCHF from Feb 1, 2019 to Feb 1, 2020. The patients were divided into three groups as tick bite, contact history, and endemic area travel according to the transmission type, and two groups according to the presence of mortality or not. The laboratory data of the patients were compared within these groups. Relationship of hemogram, C-reactive protein (CRP), D-Dimer, sedimentation, lactate, and FA levels between groups were evaluated. The average age of the patients was 62.52±14.94 years and 27(31%) of them were women. Mortality rates were in 6(6.9%) patients from endemic areas (P=0.015). While the FA level of the mortality group was 171.6±30.0 mg/L, it was 230.3±25.0 mg/L in the survivors (P=0.001). There was a moderate and strong negative correlation of FA level with mortality, tick history, and hospitalization. In ROC curve analysis of mortality and FA levels, parameters were determined as sensitivity 97.4% and specificity 96.2%. In addition to FA levels, as anticipated by our hypothesis, lactate, CRP, and sedimentation values can be used to predict prognosis and mortality in cases of CCHF.

Application of buccal mucosal graft to establish a new urination passage in male cats with penile traumatic injury.

Two male cats were presented with penile part of urethra injury due to dog attacks to the perineum and genitalia area. Chronic wound around a remained penile part of urethra due to the dog bite and perineal area was evident due to urine irritation. The buccal mucosa was harvested and subsequently placed on the granulation tissue of the wound to reconstruct the urinary passage. The buccal mucosal graft completely attached to the skin and urethra without any complications. From the follow-up at 3 months, the cats were able to urinate normally and the skin irritation from urine was resolved. In summary, the buccal mucosa is a good graft source and is suitable for the reconstruction of the urinary passage in severe and complicated cases of penile part of urethra injury in male cats.

Prolonged Bleeding due to Hirudotherapy (Medicinal Leech Therapy)

Medicinal leech therapy is a form of complementary medicine that has long been practised and is gaining popularity in recent years for various illnesses and surgical applications. However, leech saliva contains proteins with anticoagulant properties that can lead to prolonged bleeding from the bite area. We report a case of a 35-year-old male who presented to the Emergency Department due to prolonged bleeding from a leech-bite wound. He did not have any significant past medical history or medication history. He had undergone medicinal leech therapy for chronic back pain. After the therapy, he noted that the bleeding did not stop after 7 hours (which normally stops within 30 minutes) and decided to seek treatment. There were wounds over his lower back and both feet, which were all clean. The wound over the lower back had persistent oozing. We applied topical adrenaline and manual compression on the wound, and eventually the bleeding reduced and stopped. There are many suggested methods to stop bleeding from leech-bite wounds but there is scarcity of evidence regarding the superiority of any method. This is the first case report regarding bleeding complications in medicinal leech therapy in Malaysia. This report aims to raise awareness regarding the complications arising from a leech bite among the practitioners of medicinal leech therapy, the public and healthcare providers in emergency facilities. We also suggest using topical adrenaline as an alternative to help stop bleeding from leech-bite wounds.

Assessment of Age-Related Changes on Masticatory Function in a Population with Normal Dentition

This study aimed to investigate the influence of changes in age-related physiological muscular and dental factors on masticatory function. This study was conducted in 211 healthy participants divided into four different age groups: 20–45 years (Gr1); 45–60 years (Gr2); 61–70 years (Gr3); and ≥71 years (Gr4). For objective evaluation of masticatory function, the masticatory performance, bite force, posterior bite area (PBA), functional tooth units (FTUs), the number of remaining teeth, tongue pressure, masseter muscle thickness (MMT), and handgrip strength were examined. Food intake ability (FIA) and the Oral Health Impact Profile-14 score were assessed subjectively using questionnaires. A significant decrease in the number of remaining teeth, FTUs, handgrip strength, and FIA was found in Gr4, and a significant decrease in the tongue pressure, PBA, and bite force was found in those aged ≥61 years. In groups 1 and 3, an association of the PBA with masticatory performance was observed. However, there was no significant decreasing trend in the MMT with respect to masticatory performance with aging. With sufficient FTUs and posterior tooth support, although age-dependent decreases in the bite force, tongue pressure and handgrip strength were observed, masticatory performance was maintained. Establishing the PBA by improving occlusion through dental treatment is thought to be important for masticatory function.

THE MOST IMPORTANT MEDICINAL PLANTS AFFECTING BEE STINGS: A SYSTEMATIC REVIEW STUDY

Bee stings are one of the most common insect bites. In some insects, including bees, the sting, along with the venom gland, is separates from the bees' body after the bite and remains at the site of the bite. Bee stings are associated with symptoms such as redness of the skin, itching, allergic reactions causing infection, headache, dizziness, nausea, chest pain, suffocation, breathing difficulty, and paralysis of the bite area. This review study was conducted to identify Iranian medicinal plants for the treatment of bee stings. It was used to review articles in Iranian ethnobotanical sources and articles. Keywords such as bee sting, bee sting, medicinal plants, ethnobotany, identification of medicinal plants and Iran were used. Databases such as ISI Web of Science, PubMed, Scopus, ISC, ISID, Magiran and Google Scholar were used to review articles and resources. Medicinal plants such as Aloe vera, Calendula officinalis, Ruta graveolens L., Allium sativum, Heliotropium ramosissimum, Allium cepa L., Taraxacum officinale L., Rosa canina L., Petroselinum crispum, Verbascum songaricum Schrenk., Vitex pseudonegundo, Ment eriophora DC., Peganum harmala L, Citrullus colocynthis, Ocimum basilicum, Curcuma longa were among the most important medicinal plants used in Iranian ethnobotanical sources to treat bee stings. The most common plant families used for bee stings include Asteraceae and Lamiaceae. Also, the most plant organs used in bee stings included leaves (37%), shoots (20%) and flowers (14%). This study lists a number of plants that have been introduced in different parts of Iran as a treatment and antidote against bee stings and bee stings. This study introduces a number of herbs that are used in different parts of Iran as a treatment against bee stings. We believe that the plants can be used as herbal remedies and antidotes against bee stings. Lack of natural, useful and effective drugs for the treatment of bites leads to the expansion of research on effective and natural drugs for patients with bites.

MON-202 EVALUATION OF SURROGATE PREDICTORS OF MORTALITY DUE TO SNAKE ENVENOMATION AND RENAL HISTOPATHOLOGICAL CORRELATION

To evaluate the surrogate predictors of mortality due to venomous snake bite and to study the spectrum of histopathological changes of kidney in death due to venomous snake bite. One year Descriptive, Observational, Cross-sectional, Hospital and Mortuary based study. During autopsy, detailed external and internal examination was done to find the macroscopic changes at the local area of bite, kidneys. The slices of tissue from Kidneys were taken from selected cases in such a way that a slice contains all the physiological layers of the organ including diseased and normal (as seen on naked eye examination) portions with intervening transitional zone. Stained slides were examined under microscope to identify any pathological changes in kidney tissues. The findings of histopathological study were compared with that of the normal tissues. Thus the pathological process as identified in respect to the tissue involved. Macroscopic features on autopsy shows 4.1% with only congestion, congested with focal medullary haemorrhage in 36.7%, congested with patchy corticomedullary haemorrhage in 8.2%, congested with diffuse haemorrhage in 51.02%. Renal histopathological findings shows the predominant feature is Tubular Necrosis found in 57.1% of cases. 8.2% of cases shows Cortical Necrosis. Thrombi in blood vessels were found in 14.3% of cases. Of the Tubular Necrosis cases 20.4% of cases presented with dilated tubules lined by flattened epithelium & tubules shows hyalinised material in its lumen; 8.2% of cases shows small tubules containing proteinetious material in their lumen. All the cases shows features of congestion and inflammation. Haemorrhage is seen in 95.9% of cases. The predominant feature is Tubular Necrosis found in 57.1% of cases. 8.2% of cases shows Cortical Necrosis. Thrombi in blood vessels were found in 14.3% of cases. Of the Tubular Necrosis cases 20.4% of cases presented with dilated tubules lined by flattened epithelium & tubules shows hyalinised material in its lumen; 8.2% of cases shows small tubules containing proteinetious material in their lumen. All the cases shows features of congestion and inflammation. Haemorrhage is seen in 95.9% of cases. Multivariate analysis shows only number of AVS (0.020), duration of hospital stay/period of survivability (0.024), bleeding manifestations (0.000), shock/hypotension (0.000) & DIC (0.000) are positively correlated with Tubular Necrosis. With Cortical Necrosis, there is correlation with DIC (0.026) only. Whereas, only shock/hypotension (0.013) gives positive correlation with the presence of thrombi in blood vessels The prognosis for snakebite depends on factors besides hospital treatment: whether first aid is given immediately after the bite, early initiation of appropriate treatment, and the type of snake involved along with amount and severity of venom. Histopathological changes, especially in renal tissue can aid in differentiating between the nature of snake and the damage it causes.

Management of Poisonous Snake Bites: Analysis of 29 Cases

Objectives: The objective of this retrospective study is to provide contribution for management of the poisonous snake bites by comparison results of this study with the literature data. Patients and Methods: This study retrospectively analyzed the demographic and epidemiologic characteristics of 40 patients who presented due to snake bites. 29 patients were included in this study. Patients’ age, sex, month of admission, duration of follow-up in the emergency room, laboratory outcomes, the regions of snake bite, number of the bites, local and systemic symptoms, and treatment received were assessed. Patients aged under 18 years were excluded from the study. Also patients were excluded if the snakes were not seen after the patients were bitten or if they developed no local or systemic symptoms within four hours after the bite. In addition, patients in whom adequate data could not be obtained were also excluded from the study. Results: Out of the 29 patients included in this study, 15 (51.7%) were females. When the patients were examined according to local and systemic findings; local symptoms were observed in 18 patients (62.1%) and systemic symptoms in 11 patients (37.9%). There was a positive correlation between elevated ALP and diffuse edema in the bite area and hypotension findings. When durations of hospitalization were analyzed, the mean duration of hospitalization was 2.3±1.5 days. Conclusion: We believe that, symptomatic and supportive treatment could be sufficient in majority of the patients with snake bites in our region, and a low dose antiserum therapy would be reasonable when antiserum is needed.

First Aid Practices and Health-Seeking Behaviors of Caregivers for Unintentional Childhood Injuries in Ujjain, India: A Community-Based Cross-Sectional Study.

Data on types of community first aid use and treatment provided post-injury from many low‒middle-income countries, including India, are lacking. This cross-sectional study was conducted among children aged one month to 18 years of age, in Ujjain, India, to understand types of first aid given and health-seeking post-injury. A total of 1087 injuries in 1049 children were identified in the past year. A total of 729 (67%) injured children received first aid and 758 (70%) sought some form of health care. Children with burns received the most (86%) first aid, and most children (84%) with road traffic accidents (RTA) sought health care. Most children (52%) sought health care from a private health care facility; most children (65%) were transported to a health care facility within the golden hour. Motorbikes were the most preferred (50%) mode of transport. Only 1% of the injured used ambulance services. Commonly reported methods or substances for first aid included the use of coconut oil on wounds from falls (38%) and burns (44%), the use of antiseptic cream on wounds from RTA (31%), the application of turmeric for wounds from falls (16%), and rubbing of metal on a bitten area (47%). For most injuries, appropriate, locally available substances were used. Potentially harmful substances applied included lime, toothpaste, clay, and mud. The findings will help design community interventions to increase the provision of appropriate first aid for childhood injuries.

Comportamento ingestivo de ovinos em gramíneas tropicais

O objetivo desta revisão foi discutir os principais fatores que afetam o comportamento ingestivo de ovinos manejados em pastagens de gramíneas tropicais. Conhecer os hábitos destes animais é importante para se realizar o manejo adequado às suas necessidades, respeitando seu bem-estar e aumentando os índices produtivos. Ovinos pastejam basicamente no período diurno, consumindo cerca de 2-5% de seu peso corporal por dia, com tempo variando de acordo com a disponibilidade e o tipo de alimento, dificilmente ultrapassando 12 horas, pois tempos maiores interferem em outras atividades. A ruminação, atividade que demanda mais tempo depois do pastejo, divide-se em 15-20 vezes ao longo do dia, variando de poucos minutos a mais de uma hora, sendo maior à noite. A espécie forrageira, devido às suas características físico-químicas e de manejo, influencia a resposta animal. Com baixa disponibilidade de massa de forragem, os ovinos realizam até 65 bocados/minuto, mas em oferta satisfatória, essa frequência pode cair 50%. A área de bocado é afetada pela estrutura da pastagem. Com maior proporção de folhas há aumento na taxa e peso de bocados. Uma baixa proporção de folhas reduz o peso de bocados, aumenta o intervalo entre estes e o tempo total de pastejo. Os dados sobre o comportamento ingestivo de ovinos em gramíneas tropicais ainda são deficientes, havendo grande divergência entre autores.

THE PREVALENCE OF INDIAN COMMON KRAIT ENVENOMATION AND ITS CLINICAL COMPLICATIONS AMONG THE RURAL POPULATIONS OF INDIA

Snake envenomations have been a serious yet often overlooked public health threat especially in tropical and subtropical countries, including Southeast Asia. The medically important venomous land snakes in Southeast Asia include snakes from the Elapidae and Crotalidae families. Among the elapids, there are only 12 species that are considered of medical importance, represented by the kraits ( Bungarus caeruleus, B. candidus , B. fasciatus , B. flaviceps and B. multicinctus ). The incidence of snakebite is high in India. Apart from mortality, the morbidity is due to various complications. The common krait ( Bungarus caeruleus ) is the most toxic snake found commonly in the plains of throughout the India and the number of snakebites in the rural areas of India was recorded by this snake. The present article highlights the prevalence and the clinical complications of Indian common krait envenomation among the rural populations of India. Keywords: snake bite, common krait, clinical complications and rural area

Leeches: A Review on their Pathogenic and Beneficial Effects

Leech is one of the external sanguivorous parasites contributing to the reduction in productivity of livestock in different part of the World. Leeches bite the skin of the host and allow copious flow of blood preventing clot by hirudin. The bite is not painful, but the wounds may bleed for a long time and the clinical signs can be seen following this blood loss. Types of leech vary depending on ways by which they feed. Leech is segmented and lacks as hard exoskeleton; in its place it has a thin, flexible cuticle. For the most part leeches are aquatic, but terrestrial species are also found. Leeches are hermaphroditic and their feed relationships are varied. Hirudo medicinalis is the most known medicinal leech. Diagnosis can be made from clinical signs and finding the parasite in the bite area. Triclorfon, chloroform water, neguvon solution, mechanical removal, and tracheotomy in extreme cases are the best treatment approaches. Avoiding leech, depopulating infected water bodies and application of ‘endod’ to watering points are some methods of control and prevention.

Surgical Management of Snake Envenomation in India Current Perspective

India has reported one of the highest snake bite mortality rates in the world. It is estimated that over 5 million persons per year are bitten by snakes of whom, over 1,00,000 survivors develop severe sequelae due to local wound complications. The adoption of harmful first aid practices like use of tourniquets or cutting and sucking the snake bite marks further complicates wound management. National Snake Bite Protocol has been issued in 2007, with technical support from WHO to institute proper management of snake bites. However, there is no evidence based guidelines for local wound management in snake envenomation. The local tissue problems at the bite site were effectively managed by timely administration of anti-snake venom and other supportive management in majority of patients. Cribari et al have graded the local signs of envenomation. Local tissue complications are most frequently seen with bite from Viperidae. Cytotoxic enzymes in viper venom cause proteolysis, lipolysis, blisters, necrosis and gangrene. Surgical management of snake bite has a significant role in preventing late sequelae and permanent disability due to snake bite wounds. The aim of surgical intervention will be radical removal of all devitalized tissues, followed by reconstructive procedures using skin grafts and flaps, to minimize functional loss and maximize rehabilitation. This paper explores the pathology of a snake bite wound and compiles the accepted guidelines for wound management and also the do’s and don’ts pertaining to the bite areas following a snake bite.

Ontogeny of head and caudal fin shape of an apex marine predator: The tiger shark (Galeocerdo cuvier).

How morphology changes with size can have profound effects on the life history and ecology of an animal. For apex predators that can impact higher level ecosystem processes, such changes may have consequences for other species. Tiger sharks (Galeocerdo cuvier) are an apex predator in tropical seas, and, as adults, are highly migratory. However, little is known about ontogenetic changes in their body form, especially in relation to two aspects of shape that influence locomotion (caudal fin) and feeding (head shape). We captured digital images of the heads and caudal fins of live tiger sharks from Southern Florida and the Bahamas ranging in body size (hence age), and quantified shape of each using elliptical Fourier analysis. This revealed changes in the shape of the head and caudal fin of tiger sharks across ontogeny. Smaller juvenile tiger sharks show an asymmetrical tail with the dorsal (upper) lobe being substantially larger than the ventral (lower) lobe, and transition to more symmetrical tail in larger adults, although the upper lobe remains relatively larger in adults. The heads of juvenile tiger sharks are more conical, which transition to relatively broader heads over ontogeny. We interpret these changes as a result of two ecological transitions. First, adult tiger sharks can undertake extensive migrations and a more symmetrical tail could be more efficient for swimming longer distances, although we did not test this possibility. Second, adult tiger sharks expand their diet to consume larger and more diverse prey with age (turtles, mammals, and elasmobranchs), which requires substantially greater bite area and force to process. In contrast, juvenile tiger sharks consume smaller prey, such as fishes, crustaceans, and invertebrates. Our data reveal significant morphological shifts in an apex predator, which could have effects for other species that tiger sharks consume and interact with.

A five year retrospective study of fatal snakebite in Chandigarh region

This is a 5 years retrospective analysis and demographic study of cases of fatal snake envenomation presenting to the mortuary of Government Medical College & Hospital, Chandigarh, from January 2011 to December 2015. The purpose of this study is to present the epidemiological pattern of snake poisoning in this region, as also to describe the clinical characteristics and pathological changes in various organs. In our study, 49 cases of death due to snakebite were brought for medico legal post mortem examination to the Department. Of these, maximum number of cases, i.e. 15, belonged to the age group of 20–29 years; 42 were from rural areas and the time of incident of snakebite was mostly between 3 AM to 6 AM (28.5%), followed by 6 PM to 9 PM (14.3%). The months of the rainy season, i.e. July & August, accounted for the maximum no. of cases i.e. 32. The most common area of bite were the lower limbs (57%); swelling & cyanosis (41%), petechial hemorrhage (29%) and cellulitis (12%) were the common local changes at the site of bite. In 13 cases, no bite mark was seen; however, the involved limb showed local changes like swelling, ecchymosis, wet gangrene and cellulitis. Among the histopathological changes, acute tubular necrosis (41%), followed by disseminated intravascular coagulation (20%) & pulmonary oedema (12%) were the most common findings.