Snakebite Patients Research Articles

Predictors of Mortality in Vasculotoxic and Neurotoxic Snakebite Patients in a Tertiary Care Institute in Jharkhand, India

Predictors of Mortality in Vasculotoxic and Neurotoxic Snakebite Patients in a Tertiary Care Institute in Jharkhand, India

Twelve month prospective study of snakebite in a major teaching hospital in Mandalay, Myanmar; Myanmar Snakebite Project (MSP).

The Myanmar Snakebite Project is an Australian government (Department of Foreign Affairs and Trade) supported foreign aid project in collaboration with the Myanmar government with the aim of improving outcomes for snakebite patients in Myanmar. As part of the project a case record database was established to document prospective cases of snakebite presenting to Mandalay General Hospital, in Upper Myanmar. The study period was 12 months (1-2-2016 to 31-1-2017). Snake identity was based on a mixture of identified dead snakes brought with patients, doctor's clinical opinion and patient identification. 965 patients were enrolled during the 12 month period, of whom 948 were included for analysis. The male: female ratio was 1.58:1. Most cases involved bites to the lower limbs (82.5%) and adults involved in farm work, confirming snakebite as an occupational disease in this community. Motorised transport was by far the most common form of transport to health care and most patients sought care from the health system (87.7%), not traditional healers (11.5%) as their first point of contact. The officially promoted application of a pressure pad, bandage and immobilisation as first aid for snakebite was almost never used, while most patients used some form of tourniquet (92.0%). 85.4% of cases where a snake ID was listed were bitten by Russell's vipers. Russell's viper bites were responsible for all fatalities (9.8% of cases) and all cases of Acute Kidney Injury (AKI). For all cases, clinical features included local swelling (76.5%), local pain (62.6%), AKI (59.8%), incoagulable blood (57.9%), regional lymphadenopathy (39.8%), nausea/vomiting (40.4%), thrombocytopenia (53.6%), abdominal pain (28.8%), shock (11.8%), secondary infection (8.6%), panhypopituitarism (2.1%). AKI required renal replacement therapy (RRT) in 23.9% of cases, all ascribed to Russell's viper bite. Green pit viper bites were the next most common cause of bites (7.6%) and were associated with incoagulable blood (29%) and occasionally shock (5%) and local necrosis (3%), and in one case AKI not requiring RRT. In contrast to Russell's viper bites, green pit viper bite was most likely to occur in the home (49%). Some green pit viper patients were treated with Russell's viper antivenom (15%), presumably because they had incoagulable blood, although this antivenom is not effective against green pit viper envenoming. For the entire patient group, antivenom was given in 80.5% of cases. The most common indications were presence of coagulopathy/non-clotting blood (59.8%), local swelling (47.4%), oliguria/anuria (19.8%), heavy proteinuria (19.4%). A febrile reaction to antivenom was reported in 47.9% of cases, while anaphylaxis, occurred in 7.9% of cases.

A comprehensive approach to managing a neglected, neglected tropical disease; The Myanmar Snakebite Project (MSP).

Snakebite is predominantly an occupational disease affecting poor rural farmers in tropical regions and was recently added to the World Health Organisation list of Neglected Tropical Diseases (NTD). We document an overview of methodologies developed and deployed in the Myanmar Snakebite Project, a foreign aid project largely funded by the Australian Government, with the core aim to “improve outcomes for snakebite patients”. A multidisciplinary team of experts was assembled that worked in a collaborative manner with colleagues in Myanmar, first to identify problems related to managing snakebite and then develop interventions aimed to improve selected problem areas. A broad approach was adopted, covering antivenom production, antivenom distribution and health system management of snakebite. Problems identified in antivenom production included poor snake husbandry resulting in poor survival of captive specimens, lack of geographical diversity; poor horse husbandry, resulting in high mortality, inadequate stock acquisition protocols and data collection, and inappropriate immunisation and bleeding techniques; and inadequate production capacity for freeze dried antivenoms and quality control systems. These problems were addressed in various ways, resulting in some substantial improvements. Antivenom distribution is being reorganised to achieve better availability and utilisation of stock. Health system management of snakebite was assessed across all levels within the area selected for the study, in Mandalay region. A comprehensive community survey indicated that hospital statistics substantially underestimated the snakebite burden, and that access to care by local villagers was delayed by transport and cost issues compounded by lack of antivenom at the most peripheral level of the health service. A health system survey confirmed under-resourcing at the local village level. Prospective case data collection initiated at tertiary hospitals indicated the extent of the snakebite burden on health resources. Interventions initiated or planned include training of health staff, development of a core of senior trainers who can “train the trainers” nationwide in a sustainable way, development and deployment of management guidelines and algorithms for snakebite and a distribution of solar powered fridges to remote health facilities to allow storage of antivenom and prompt treatment of snakebite cases before transfer to major hospitals, thereby reducing the “bite to needle” time.

In vitro Kinetics Study of Cerastes Cerastes Phospholipase A2 using Olive Leaf Extract: A Fluorescence Approach

Understanding snake venom kinetics is crucial for developing risk evaluation strategies and determining the best dose and timing of antivenom required to bind all venom in snakebite patients. Polyphenolic compounds have shown to inhibit toxic effects induced by snake venom proteins. The interaction of polyphenols with Phospholipase A2 of Cerastes cerastes snake venom was investigated by fluorescence spectroscopy. The decrease in the fluorescence versus time was conducted at room temperature in 0.01 M Tris, 0.1 M NaCl at pH 7.4. The decrease in fluorescence was following a pattern of zero-order kinetics rate in which the fluorescence is decreasing linearly with time. This study is expected to offer additional information about the interactions of PLA2 with natural product that might lead to therapeutic drug

Assessment of clinical parameters among patients with snake poison induced coagulopathy

Background: Snakes are poikilothermic carnivorous reptiles that have evolved the venomous apparatus for the purpose of procurement of food. Snake bite can result in local and systemic complications. Major systemic complications include acute renal failure, neurologic abnormalities requiring ventilator support and disseminated intravascular coagulation. Disseminated intravascular coagulation can result in serious life-threatening systemic complications like haemorrhage, infarction and even death if the treatment is delayed. The present study was undertaken to study the clinical profile of the snake bite patients who develop coagulopathy and to study the role of coagulation markers to evaluate the morbidity and mortality of snake bite victims.Methods: Hundred patients consecutively admitted with history of snakebite were studied. Patients who have developed local signs of envenomation due to snake bite were included in the study group. The coagulation profile was assessed by doing blood investigations.Results: In this study, patients who developed coagulopathy had prolonged hospital stay and requirement of more blood products transfusion causing increased morbidity. 43 patients (35.8%) had platelets less than 1 lakh and approximately hospitalized for 26 days sand INR was more than 1.5 in 112 patients (93.3%) and hospitalized for 22 days and they received fresh frozen plasma. The survival rate in this study was 86% followed by 13.3% deaths.Conclusions: Use of clinical and laboratory parameter evaluation needed to identify the coagulopathy very early to reduce the hospital stay and mortality.

Incidence of snakebites in 3 different geographic regions in Thua Thien Hue province, central Vietnam: Green pit vipers and cobras cause the majority of bites

BackgroundThe annual incidence of snakebites in Vietnam is not known and only few publications about snakebite envenoming and medically relevant snakes can be found in English language literature. The present community-based surveys provide data on incidence of snakebites in three different geographic regions of Thua Thien Hue (TT Hue) province, central Vietnam and snake species responsible for bites in this region. Methodology/resultsThe cross-sectional community based surveys were conducted from March to July 2017. Multistage cluster sampling was applied and snakebite incidence was calculated at 58 snakebites per 100,000 person-years for the entire province, and 172, 69 and 10 snakebites per 100,000 person-years in the mountainous, coastal and urban region of TT Hue province, respectively. Thirty-one snakebite victims interviewed during the surveys reported 18 (58%) green pit viper bites (Trimeresurus species), 5 (16%) cobra bites (Naja kaouthia, Naja siamensis), 2 (7%) krait bites (Bungarus candidus, Bungarus fasciatus), 2 (7%) red-necked keelback bites (Rhabdophis subminiatus) and 4 bites from unidentified snakes (13%). The outcome was favourable for 28 snakebite victims (90%), two (6%) had minor sequelae and one (3%) victim died after a Malayan krait bite. Two hundred and twenty-one snakebite patients were treated in 9 district hospitals and one central hospital in TT Hue between 2014 and 2016. Eighty green pit vipers (84%), 12 cobras (13%) and 3 kraits (3%) were responsible for bites in 95 patients where snake identification was documented. ConclusionsIncidence of snakebites is surprisingly low in TT Hue province in central Vietnam in comparison to other regions in Asia, particularly to neighbouring Lao PDR. However, snakebites are still a significant health problem in the mountainous region and green pit vipers and cobras cause the vast majority of bites.

Predicting acute renal failure in Bothrops snakebite patients in a tertiary reference center, Western Brazilian Amazon.

Acute Kidney Injury (AKI) is the main systemic complication and cause of death in viperid envenomation. Although there are hypotheses for the development of AKI, the mechanisms involved are still not established. The aim of this study was to evaluate the clinical-laboratorial-epidemiological factors associated with AKI in victims of Bothrops sp envenomation. This is an observational study carried out at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. AKI was defined according to the guidelines of the Acute Kidney Injury Network (AKIN). Among the 186 patients evaluated, AKI was observed in 24 (12.9%) after 48 hours of admission. Stage I was present in 17 (70.8%) patients, II in 3 (12.5%) and III in 4 (16.7%). Epidemiological characterization showed predominance of men, occurrence in rural areas, aged between 16–60 years, feet as the most affected anatomical region, and time to medical assistance less than 3 hours. Hypertension and diabetes were the comorbidities identified. Most of the accidents were classified as moderate, and clinical manifestations included severe pain, mild edema, local bleeding and headache. Laboratory results showed blood uncoagulability, hypofibrinogenemia, leukocytosis, increase of creatine kinase, and high lactate dehydrogenase levels. Multivariate analysis showed an association with high LDH levels [AOR = 1.01 (95% CI = 1.01–1.01, p<0.002)], local bleeding [AOR = 0.13 (95%CI = 0.027–0.59, p<0.009)], and the presence of comorbidities [AOR = 60.96 (95%CI = 9.69–383.30; p<0.000)]. Herein, laboratory markers such as high LDH levels along with local bleeding and comorbidities may aid in the diagnosis of AKI.

Antivenom administration was associated with shorter opioid use in copperhead snakebite patients

Antivenom administration was associated with shorter opioid use in copperhead snakebite patients

Snakebite incidence in two townships in Mandalay Division, Myanmar.

IntroductionThe global incidence of snakebite is estimated at more than 2.5 million cases annually, with greater than 100,000 deaths. Historically, Myanmar has one of the highest incidences of venomous snakebites. In order to improve the health outcomes of snakebite patients in Myanmar, access to accurate snakebite incidence data is crucial. The last population-based study in Myanmar was conducted more than a decade ago. In 2014, the Ministry of Health and Sports data from health facilities indicated an incidence of about 29.5 bites/ 100,000 population/year (a total of 15,079 bites). Since data from health facilities lack information about those who do not seek health care from government health services, a new population-based survey was conducted in 2 rural areas of Mandalay region. The survey data were compared to those obtained from healthcare services.Method4,276 rural respondents in Kyaukse and Madaya townships in Mandalay Division were recruited using cluster sampling that involved random selection of 150 villages and random sampling of 30 households from each village. One adult member of each household was interviewed using a structured questionnaire.ResultsOne respondent from each of 4,276 households represented 19,877 residents from 144 villages. 24 people in these households had suffered snakebite during the last one year giving an annual incidence of 116/100,000. During the last ten years, 252 people suffered snakebites. 44.1% of the victims were women. 14% of the villages reported 4 or more bites during the last ten years, whereas 27% villages reported no snakebites. 92.4% of the victims recovered fully, 5.4% died, and 2% suffered long term health issues. One victim was reported to have died from causes unrelated to the snakebite. While there was no statistically significant difference between outcomes for children and adults, 4 of 38 of those under 18 years of age died compared to 7 of 133 adults between 19 to 40 years of age.ConclusionThis incidence reported by the community members points to substantially more snakebites than the number of snakebite patients attending health facilities. This higher incidence points to the need for a nation-wide population-based survey, community education about gaining access to care where antivenom is available, and to the potential need for a larger supply of antivenom and expansion of medical care in rural areas.

Safety of nonsteroidal anti-inflammatory drugs in copperhead snakebite patients

Introduction: Current management guidelines for pit viper envenomations recommend against the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control due to concern for platelet dysfunction and resulting coagulopathy. However, prior research suggests that copperhead snakes generally do not cause coagulopathy and they are responsible for most of the venomous snakebites in the USA. Thus, we compared the occurrences of clinically apparent bleeding and most abnormal laboratory values of coagulation between copperhead envenomation patients who received NSAIDs and those who did not.Methods: We conducted a retrospective chart review of patients who presented to our adult and pediatrics emergency department with copperhead snakebites. We recorded patient demographics, snake type, any NSAIDs given, any opioid analgesics given, any documented bleeding, and most abnormal laboratory values of coagulation.Results: There was no significant difference in most abnormal PTT, fibrinogen, platelet count, and serum creatinine values between copperhead snakebite patients who received NSAIDs and those who did not. Mean INR was lower (p = .011) and hematocrit was higher (p = .018) for NSAID-treated patients than for patients treated without NSAIDs. Three patients demonstrated clinically apparent bleeding; two had epistaxis reported at an outside hospital but received NSAIDs without further bleeding at our hospital. The third had 3 + blood on a urinalysis that was attributed to a urinary tract infection and also received NSAIDs without any other bleeding.Conclusions: There were no bleeding outcomes attributable to NSAID usage among copperhead snakebite patients. The use of NSAIDs in managing pain and inflammation in identified copperhead snakebite patients appears safe.

Delayed double reading of whole blood clotting test (WBCT) results at 20 and 30 minutes enhances diagnosis and treatment of viper envenomation

BackgroundThe whole blood clotting test (WBCT) is a simple test of coagulation that is often used in the assessment, diagnosis, and therapeutic monitoring of snakebite patients in sub-Saharan Africa. WBCT requires only a clean glass tube and several milliliters of venous blood and is ideal for use in poorly equipped health centers throughout the rural areas where 95% of snakebites occur. However, questions surrounding the accuracy and reliability of the test remain unanswered due to variations in testing conditions and a lack of comparative research with which to validate them. This is the first study to evaluate WBCT results at both 20-min (WBCT20) and 30-min (WBCT30) reading times in the same group of snakebite patients.MethodsIn order to define the best reading time, the authors compared the results of serial WBCT evaluation at both 20 and 30 min after collection in 23 patients treated for snake envenomation in Bembèrèkè, northern Benin.ResultsWBCT results were identical at both reading times in patients without coagulopathy or when coagulation was restored permanently following a single dose of antivenom. Out of 17 patients with coagulopathy, 14 showed discrepancies between WBCT20 and WBCT30 results in at least one pair of serial evaluations. These could be completely contradictory results (e.g. normal clot at WBCT20 and no clot at WBCT30) or a marked difference in the quality of the clot (e.g. no clotting activity at WBCT20 and an unstable partial clot at WBCT30). WBCT discrepancies were encountered most frequently in three situations: initial normalization of hemostasis following antivenom therapy, detection of a secondary resumption of coagulopathy, or final restoration of hemostasis after a secondary resumption had occurred.ConclusionsThis study suggests that the WBCT is robust and that a sequential reading should improve the diagnosis and monitoring of venom-induced coagulopathies. It also indicates the possibility of discrepancies in the sensitivity of WBCT20 and WBCT30 for detecting the resolution or reoccurrence of coagulopathy and identifies how these findings, if confirmed, may be used to increase the efficacy and efficiency of antivenom treatment in the field.

An Epidemiologic and Clinical Study of Snake Bites during a Five-Year Period in Karoon, Iran

Background:Snakebite is one of the most common health problems in endemic regions such as Iran. Due to the potential life-threatening impact of snake envenomation and biodiversity of snakes, it seems that epidemiological studies are required, as the primary step to design standard and local therapeutic protocols, regarding the national and regional facilities and therapeutic needs. Methods:This investigation was conducted with a retrospective design, by studying all the records of patients affected by snakebite and hospitalized in Sina Hospital during 2006 to 2011. Epidemiological data and also the outcomes of patients (including side effects and survivals) were collected. The data were analyzed by SPSS software version 18, using descriptive statistics and Chi-Square test. P < 0.05 was considered as significant. Results:A total of287 snakebite patients were studied. 73.5% of patients were men and most of them belonged to the age group of 15-34 years. Most common complaints of patients once admitted were pain (74.6%) and edema (43.9%). 96.5% of the patients received 5-10 vials of anti-venom. The most prevalent side effect observed was coagulopathy (70.7%). A significant relationship was found between the anti-venom onset after the bite and the rate of coagulopathy occurrence (p=0.035). Three deaths had occurred in general. Conclusion:Early referral to medical centers and administration of anti-venom has been accompanied by significant improvement in outcomes, and would reduce the hematological side effects, need for administrating blood products, and probably the need for administration higher anti-venom doses.

Why snakebite patients in Myanmar seek traditional healers despite availability of biomedical care at hospitals? Community perspectives on reasons.

BackgroundSnakebite is a major public health problem in many developing countries. Farmers are particularly exposed to snakes, and due to their rural location often experience delays in accessing formal healthcare. The reasons to use traditional healers may include difficulties in accessing formal healthcare, certain beliefs about snakes and snake venom, tradition, and trust in the capacity of traditional healers. Traditional healing, however, may have serious consequences in terms of delays or added complications. There is little in-depth current information about the reasons for its continued use for snakebite. As part of a health services development project to improve health outcomes for snakebite patients, community attitudes to the use of traditional healers were explored in the Mandalay region of Myanmar.Methodology & findingsWith the objective of learning from local communities, information was generated in three communities using participatory appraisal methods with the communities, and focus group discussions with the local healthcare staff. Many snakebite victims in these communities use traditional healing. Reasons include transport difficulties, low cost for traditional healing, inadequacy of anti-snake venom in the formal healthcare sector, and traditional beliefs, as traditional healing practices are rooted in many cultural and traditional factors. The communities reported that even if access to medical care were improved, traditional healing would continue to be used.ConclusionThese findings point to the need for working with traditional healers for prevention, appropriate first aid and timely access to effective treatment for snakebite.

Evidence-based study of snakebite complicated with tetanus infection

Objective To analyze the literature of snakebite and infection at home and abroad, and understand the situation of in snakebite patients. Methods The retrieval of China CNKI database, Wanfang database, VIP database and MEDLINE, Web of Science Embase and Science Direct database was performed with snake and tetanus as the key words, and the retrieval time from January 1953 to October 2017. Results A total of 98 articles was retrieved, which clearly records the snakebite patient data with has collected 8 literatures, Chinese 6 literatures, English 2 articles; a total of 16 patients, including 11 cases of Chinese, 4 in Nigeria, 1 in Thailand; the bite sites were limbs; 9 patients with blood circulation the snake wound, 7 cases of mixed snakebite; snake bite patients with before; 1 patients were injected with Tetanus Antitoxin, 13 patients were treated with Chinese herbal medicine on the wound, 2 patients were untreated. Prognosis analysis showed that in 16 cases, 12 cases were cured, 4 cases died, and the death of the patients had the history of herbal. Conclusions The prevention of infection should be strengthened in patients with extremities trauma, external application of herbs, blood based drugs, or mixed venomous snake bites. Key words: Snake bites/CO; Tetanus/ET; Evidence-based medicine

Snake bites with Neuropsychiatric Presentation ─ A Study in Hill Tracts of Bangladesh

Background: Snake bite is a common medical emergency and one of the important causes of mortality and morbidity in hill tracts of Bangladesh. Neurological and psychiatric features predominate as both early and late features of snake bite patients and need to be identified correctly for proper management.Objective: The aim of this study was to find out the pattern of early and late neuropsychiatric manifestations of snake bite in hill tracts with clinical outcomes.Materials and Methods: This descriptive hospital-based study was done on 121 snake bite patients during the period from January 2015 to July 2016 using simple, direct, standardized questionnaire with history, neurological examination and psychiatric evaluation.Results: Majority of cases (71.9%) were admitted into hospital after two hours of snake bite. Lower limb was the commonest site (75.2%) of bite. Generalized weakness (50.4%) and anxiety (52.9%) were the commonest early neurological and psychiatric manifestations. Numbness (57%) and depression (33.9%) were the commonest late neurological and psychiatric manifestations among survivors; 37.2% needed referral to tertiary care hospital and 34.7% received antivenom. Death rate was 17.4% and 73.6% were cured completely without complication.Conclusion: As neurological and psychiatric manifestations are common in both early and late stages in snake bite in hill tracts, these are to be considered in the total management to decrease mortality and morbidity.J Enam Med Col 2018; 8(1): 20-24

Pharmacokinetics of Snake Venom.

Understanding snake venom pharmacokinetics is essential for developing risk assessment strategies and determining the optimal dose and timing of antivenom required to bind all venom in snakebite patients. This review aims to explore the current knowledge of snake venom pharmacokinetics in animals and humans. Literature searches were conducted using EMBASE (1974–present) and Medline (1946–present). For animals, 12 out of 520 initially identified studies met the inclusion criteria. In general, the disposition of snake venom was described by a two-compartment model consisting of a rapid distribution phase and a slow elimination phase, with half-lives of 5 to 48 min and 0.8 to 28 h, respectively, following rapid intravenous injection of the venoms or toxins. When the venoms or toxins were administered intramuscularly or subcutaneously, an initial absorption phase and slow elimination phase were observed. The bioavailability of venoms or toxins ranged from 4 to 81.5% following intramuscular administration and 60% following subcutaneous administration. The volume of distribution and the clearance varied between snake species. For humans, 24 out of 666 initially identified publications contained sufficient information and timed venom concentrations in the absence of antivenom therapy for data extraction. The data were extracted and modelled in NONMEM. A one-compartment model provided the best fit, with an elimination half-life of 9.71 ± 1.29 h. It is intended that the quantitative information provided in this review will provide a useful basis for future studies that address the pharmacokinetics of snakebite in humans.

The Analysis of the Treatment of Rhabdomyolysis by Snake Bites

Objective: To explore the treatment measure of rhabdomyolysis caused by snake bites, and provide guidance for further prevention and control of snake bites. Methods: To retrospectively analyze the 841 cases of serpentine bites in our hospital from January 2006 to July 2017; 127 cases of patients with rhabdomyolysis syndrome were screened out, and their clinical manifestations, laboratory results, related treatment and prognosis were analyzed. Results: 127 cases patients were rhabdomyolysis out of 841 cases, 28 cases patients developed acute renal failure; treatment measures included local wound treatment, application of tetanus antitoxin, anti-snake venom serum, anti-infection, fluid “hydration” and diuretic, alkaline urine and hybrid renal replacement therapy. 112 cases were cured, improved conditions in 9 cases, 3 cases of death, 3 cases uncured. The improvement rate of is 95.26% after treatment. Conclusion: The rhabdomyolysis had a high incidence in snake bite patients, severe cases often developed acute renal failure. Serum myopsin and related biochemical blood tests could be used to diagnose rhabdomyolysis quickly. Combined treatment methods are the main measure to increase the cured rate and decrease the death rate.

Drug usage in the management of snake bite patients in a tertiary care teaching hospital - A retrospective study

Background: Snake bite is an important medical emergency and an occupational health hazard in India especially in rural population. In the developing countries, it has been reported that about 80% of the snake bite patients first consult traditional practitioners before approaching the hospital and the delay in transportation leads to mortality. Thus, the actual incidence of mortality due to snake bites in India especially in Jammu and Kashmir may be much higher as a large number of cases remain unreported. Objective: The objective of the study was to study the drug usage pattern in the management of snake bite patients in a tertiary care teaching hospital. Materials and Methods: This was an observational retrospective study conducted over a period of 3 months. The medical records of snake bite patients during the study period were reviewed to extract information regarding demographics (age and gender), site of bite, clinical features, anti snake venom (ASV) administration, and pattern of concomitant drugs used. The data thus obtained were filled in a pre-designed pro forma and analyzed with the help of descriptive statistics. Results: In the present study, data of 76 snake bite patients were analyzed. Males 52 (68.4%) were predominantly affected as compared to females 24 (31.6%). The mean age of the patients was 35.26 ± 14.11 years. As per site of bite, it was observed that lower limbs were most commonly affected in 84.2% of patients whereas 12 (15.8%) patients had a bite over upper limbs. Nearly 35 (46.1%) patients received ASV within 6 h following bite. Concomitant drugs used were tetanus toxoid in 81.6% patients and antibiotics in 53.9% of patients. Conclusion: Snake bite, though preventable yet remains to be one of the common medical emergency. Thus to decrease the mortality associated with this disease, it is need of the hour to make patients and community aware of correct first aid measures, quick transport and should also be imparted other important information such as not to walk barefooted and not to sleep on floor the training of primary level health workers will also be of immense help in educating the people.

Clinico-epidemiological profile of snake bite in children - A descriptive study

Background: Snakebite is one of the important causes of occupational hazard in our country. The state of Bihar has the third largest number of snakebite deaths in India. Objective: Our aim was to study the clinical profile, seasonal pattern, complications and outcome in patients of snake bite in pediatric age group. Materials and Methods: This was a record-based retrospective study conducted at Sri Krishna Medical College, Muzaffarpur. Data were collected for patients admitted between 1 July 2015 and 30 June 2016. Patients were included if they had a history of snakebite or unknown bites. Results: There were 51 males (60%) and 34 females (40%) out of 85 patients studied. Among them, 50 patients had krait bite, 25 patients had Cobra bite, 2 patients had viper bite, and in 8 patients snake was not identified. Majority of the snake bites were in the lower limbs (80.0%). The highest number of cases occurred during June-October month (42%). Mortality in our study was 6%. The most common symptom detected was pain abdomen (80%), ptosis/ophthalmoplegia (82.35%), altered sensorium (29.41%), and respiratory difficulty (35.29%). Conclusions: Common krait (Bungarus caeruleus) accounted for the highest number of venomous bites. Lower limb was the most common bitten site. Victims were from a rural background, and most of them were bitten indoors and during the night time. Identification, timely diagnosis and early administration of anti-snake venom will certainly aid to curb mortality in snake bite.

A prospective observational study of drug usage in the management of snake bite patients and their outcome in a tertiary care teaching hospital

Background: The objectives of the study were to assess the pattern of management of snakebite especially with respect to use of anti- snake venom and other supportive treatment given and to assess the effect of anti-snake venom on different types of snakebite and to assess their outcome.Methods: A prospective observational study was conducted over a period of 6 months, after getting approval from Institutional Ethics committee. Total of 144 snake bite patients were analysed for six months duration for use of anti-snake venom and other supportive treatment in their management and were assessed for their outcome like recovery, morbidity and mortality.Results: Out of 144 snake bite patients analysed, 71.5% had poisonous type and 28.4% had non- poisonous type of snake bite. Among the total number of snakebites, 47.2% were unknown type and among the known type 25% were viper, 13.2% cobra, 7.6% krait, 6.3% sea snake and 0.7% green snake. Anti-snake venom (ASV) was given to 62 patients depending on severity, of which, 22 patients developed reaction to ASV. Patient with reaction to ASV were treated with corticosteroid and antihistamine injection. Morbidity was seen in 29.1% of patients who developed either cellulitis or gangrene of bitten area, which was more commonly seen among viper bite patients (54.7%).Conclusions: Snakebite is one of the commonest tropical diseases leading to envenomation and poisoning especially in rural areas of tropical countries which has to be treated as early as possible to prevent complications. Majority of the cases in our study were of viper bite and most of them have recovered after treatment.