Russell's viper bites in Taungdwingyi Civil Hospital:Clinical features and respones to antivenom

One hundred thirty-four Russell's viper (Daboia russell siamensis) bite cases were studies in Taungdwingyi during six months from June to December 1994. Forty percent of the victims were under 20 years of age. Thirty-eight percent showed no evidence of envenoming, 28 percent had local and 34 percent systemic features of envenoming. Ten percent of the cases developed local necrosis. Fifteen percent of the victims received antivenom therapy at the villages. Cases presenting with systemic manifestations had spontaneous systemic bleeding (29 percent); malena (18 percent), hypotension (22 percent), oliguria (42 percent), conjunctival oedema (18 percent) and renal failure (33 percent). Twelve deaths (9 percent) were due to hypotension and renal failure. Spontaneous systemic bleedings were late manifestations and seen from day 2 to 6 after the bite. Thirty-seven percent of the cases with systemic bleeding failed to have normal clot restoration in 6 hours following 40 ml of antivenom administration. Antivenom reactions were observed in 50 percent of the cases. Fifty two percent of juvenile and 19 percent of adult viper bites resulted in blank bites and 16 percent of the former and 31 percent of the latter bites led to systemic envenoming.

Clinical significance of early intravenous antivenom in russell's viper bite casces in Taungdwingyi District:A preliminary study

A retrospective study of 26 Russell's viper (Daboia russelii siamensis) bite cases who received 1-2 ampoules of anti venom at the villages in Taungdwingyi Township was carried out. Sixteen pad-applied cases were included in the study. Pad-treated cases who received early anti venom irrespective of the time after the bite developed no systemic complications (n=0/4) compared to those without pad (n=7/8) or cases who received 4 ampoules of antivenom within 4 hours after the bite at the hospital (n=5/10). Those who received antivenom 4 hours after the bite at the villages irrespective of pad carried the same risk of developing systemic complications compared to those who received 4 ampoules of antivenom at the hospital. Early administration of 1-2 ampoules of anti venom is indicated for treatment of local envenomed cases and 4 ampoules of antivenom should be given to early systemic cases following bites of big snakes. Application of compression immobilisation first-aid technique with an early intravenous anti venom at the villages is to be recommended in Russell's viper bite cases. Antivenom could have been saved in 24 percent of snake bite cases if guidelines for antivenom therapy were properly followed.

A study of patients with ammonia poisoning

This study was undertaken to determine the clinical course of ammonia poisoning admitted to North Okkalapa General Hospital after accidental burst of ammonia tank in ice factory of South Okkalapa Township. Total number of five patients were admitted to NOGH medical ward in Oct; 1993. All patients were suffering from conjunctivitis, keratitis, pharyngitis, laryngitis, bronchitis and pneumonitis. Among these five patients, only two patients had severe pneumonitis. All patients recovered but one patients had corneal opacity and two patients had persistant bronchitis. This figure was compared with other reports. Although it is a rare occupational hazard in Myanmar, we would like to alert all clinicians and persons concerned because our nation is trying to become an industrialized country.

Biological properties of Russell's viper venoms of upper and lower Myanmar

Biological properties and SDS-PAGE electrophoresis of Russell's viper venoms of Magwe (upper Myanmar) and Ayeyarwaddy divisions (lower Myanmar) were carried out following recommended techniques. Double diffusion and immunoblotting of venom and antivenom were also performed. There are inter and intradivisional variations in venom properties and in electrophoretic pattern. Biological properties of venom of Magwe and Ayeyarwaddy divisions are comparable except the former has weak procoagulant and potent defibrinogenating activities whereas the latter has potent procoagulant and weak defibrinogenating activities. Qualitative and quantitative differences in protein bands are recognized in precipitin reaction and in immunoblotting. These differences in venom properties and venom-antivenom reaction may account for variation in clinical pictures of Russell's viper bite cases of upper and lower Myanmar and variable performance of antivenom.

Geographical variation of biological properties of Russell's viper (Daboia Russelli Siamensis) venom: Magwe Division

Biological properties of Russell's viper venoms from two localities (Lokekogwa of Taungdwingyi township and Myehte) of Magwe division were studied in rodents according to WHO recommended techniques. SDS-PAGE electrophoresis of venoms was also carried out. Adult viper venom of Taungdwingyi possesses potent lethality, difibrinogenating, haemorrhagic and necrotic activities compared to young viper. Its lethality, procoagulant and capillary permeability increasing activities are more potent than Myehte venom, but the latter is slightly more haemorrhagic and necrotic than the former. SDS-PAGE electrophoresis of venoms shows qualitative and quantitative differences in protein bands. It may be concluded that adult Russell's viper venoms of Magwe division have weak procoagulant and potent defibrinogenating activities.

Biological properties of Russell's viper venoms of upper and lower Myanmar

Biological properties of Russell's viper venoms of Magwe (upper Myanmar) and Ayerawaddy (lower Myanmar) divisions were studied following recommended techniques. SDS-PAGE electrophoresis and immuno-blotting of venoms were also performed. Neutralisation of Taungdwingyi and Daedaye venoms by a monovalent antivenom was also tested. There are inter and intradivisional variation in venom properties and in electrophoretic pattern. Biological properties of venoms of Magwe and Ayerawaddy divisions are comparable however the latter has strong procoagulant activity. Qualitative and quantitative differences in protein bands are recognised in immunoblot. Two of 32 times greater amount of antivenom is needed to neutralise different biological properties of Taungdwingyi venom compared to that of Daedaye. These differences in venon properties and antivenom reactivity may account for variation in clinical pictures of Russell's viper bite cases of Myanmar and variable performance of antivenom.

Variation in biological properties of russell's viper venoms of Magwe division

Biological properties of Russell's viper venoms form two locallities (Kokekogwa, Taungdwingyi and Myehte) of Magwe division were studied in rodents according to WHO recommended techniques. SDS-PAGE electrophoresis of venoms was also carried out. Adult viper venom of Taungdwingyi possesses potent lethality and defibrinogenating activities and is more haemorrhagic and necrotic than venom of ypung viper. It's lethality, procoagulant and capillary permeability increasing activities are more potent than Myehte venom but the latter is slightly more haemorrhagic and necrotic than the former. In SDS-PAGE electrophoresis, qualitative and quantitative differences in protein bands were observed. It may be concluded that venoms of Magwe division have weak procoagulant and potent defibrinogenating activities and biological properties of venom of adult viper of Taungdwingyi is more potent than that of young viper.

Trial of combined chloroquine tetracycline therapy on vivax malaria

This clinical trial with combination of Chloroquine and Tetracycline therapy on vivax malaria on twenty patients has shown that it is very effective for radical cure therapy. It is to be recommended in place of chloroquine-primaquine combination, which is more costly and not available at times.