Knowledge on prevention and management of snake bite among adults in rural area of West Bengal

Background: Snake bite and its consequences may be largely prevented with adequate knowledge. Better knowledge can lead to positive attitude and subsequently good practices. Hence, it is of utmost need that people should have adequate knowledge regarding snake bite and its management. Aims and Objectives: The aims of this study were to assess the knowledge regarding prevention and management of snake bite among adults in a rural area of West Bengal and to find out any association between sociodemographic profile and knowledge on prevention as well as management of snake bite among the study participants. Materials and Methods: A community-based and observational descriptive study was conducted in the rural field practice area of Medial College, Kolkata, West Bengal for of 2 months. The study participants who were willing to participate in the study and gave written informed consent were included in the study. A pre-designed, pre-tested, and semi-structured data collection form was used. It was developed based on similar type of previous studies and was modified according to the local culture. The data collection form comprised sociodemographic profile of the study participants, their knowledge regarding snake bite, and its prevention and availability of first aid management. Results: A total of 134 participants were included in the study. The mean age was 45.81 ± 8.00 years. It was observed that majority of the study subjects believed in the knowledge that all types of snakes are poisonous (93.2%) and leads to death (90.3%). First aid measures such as application of tourniquet that was seen in only 4.4% of the cases. However, more than half of the study subjects (71.6%) believed in sucking the venom out of the wound. It was noted that higher education status, improved social class had better knowledge score of snake bite prevention and management as compared to their counterparts and this association was found to be statistically significant (P < 0.001). Conclusion: Knowledge of the study subjects on snake bite and its prevention is good, but still a large number of participants have inadequate knowledge on snake bite and its prevention. Community-based awareness program on prevention and management of snake bite, use of personal protective measures, and training of peripheral health workers ware specifically recommended.

Fatal intracranial bleedings in a viper bite: A case report / 中华创伤杂志(英文版)

Viper bite envenomation represents a significant occupational hazard among agricultural workers in India. The viper bite envenomation is usually suspected when a patient presents with predominant local symptoms at the bitten site, including pain, swelling, and necrosis. Further, systemic findings such as diffuse intravascular coagulation, hypotension, and shock may alert physicians of viper bite envenomation rather than a neurotoxic snake bite. However, cerebral complications are rare in viper bites but may potentially fatal. Central nervous system involvement in a viper bite is either due to neurotoxins or hemorrhagins present in the venom, which may induce cerebral thrombosis, ischemia, infarction, and hemorrhage. Here we present a case of a previously healthy adult male who succumbed to extensive subarachnoid, intracerebral, and intraventricular hemorrhages involving bilateral cerebral hemispheres following viper snake bite envenomation. This report highlights the importance of anticipating cerebral complications in viper bite envenomation, a rare occurrence. It also emphasizes the need for early antisnake venom administration to prevent and control systemic envenomation and its complications.

Compartment Syndrome Secondary to Bothrops spp. Envenomation in Triângulo Mineiro, Region, Minas Gerais, Brazil

ABSTRACT Background: Snakebite is a neglected global health problem with high morbidity. We describe compartment syndrome (CS) cases related to snakebites by Bothrops spp. Methods: The medical records of patients admitted with snakebites envenomation were reviewed. Results: Of 47 patients with Bothrops spp. envenomation (4 male; mean age: 42 years), 7 (15%) developed CS. The mean time to antivenom administration was 9.5 hours. The time to fasciotomy was variable. Seven patients developed infection and four had acute kidney injury. Conclusions: The incidence of CS is higher than that reported previously. This may be due to the clinical severity and long delay before administering antivenom.

Mordeduras de ofidios en mano pediátrica y sus complicaciones locales / Snake bites in pediatric hand and their local complications / Mordidas de serpentes de mão pediátricas e suas complicações locais

Introducción: el envenenamiento por mordedura de ofidios es reconocido como un problema de salud pública según la Organización Mundial de la Salud. La baja incidencia sumada a la diversidad de presentaciones clínicas, edades, topografías afectadas, así como los diferentes protocolos en la bibliografía existente sobre algunos aspectos del tratamiento, hacen difícil el manejo sistematizado de estos pacientes. El objetivo de este trabajo es realizar una revisión sistemática de la literatura sobre mordedura de serpientes en pacientes pediátricos con afectación en mano y miembro superior, haciendo hincapié en la conducta frente las complicaciones loco-regionales. Por importancia y frecuencia destacamos al síndrome compartimental, las flictenas y las infecciones. Metodología: se realizó una búsqueda bibliográfica en MedLine/PubMed con las palabras clave: "Snake Bite hand Children" y "Snake Bite compartimental syndrome". Se incluyeron los artículos publicados en los últimos 10 años (2012 al 2022). Resultados: la búsqueda de artículos ante las palabras "Snake Bite hand Children" resultó en 20 articulos y la busqueda ante las palabras "Snake Bite compartimental syndrome" derivó en 34. Luego de aplicar los criterios de inclusión y exclusión se obtuvieron 30 artículos para el análisis. Conclusiones: la población pediátrica se encuentra más expuesta a las mordeduras por serpientes y a su vez a presentar lesiones más severas. El tratamiento del síndrome compartimental continúa siendo un tema de debate. El veneno inoculado puede simular un síndrome compartimental que puede revertir sin fasciotomías con el tratamiento adecuado. Igualmente, ante síntomas y signos claros de síndrome compartimental se sugiere realizar fasciotomías frente a las graves secuelas potenciales. Ante la aparición de flictenas, el destechado cuidadoso de la misma es un tratamiento adecuado. La mayoría de los autores coinciden con el tratamiento profiláctico con antibioticoterapia.

Introduction: Ophidian bite poisoning is recognized as a public health problem by the World Health Organization. The low incidence added to the diversity of clinical presentations, ages, affected topographies, as well as the different protocols in the existing literature on some aspects of treatment, make the systematized management of these patients difficult. The aim of this work is to carry out a systematic review of the literature on snakebite in pediatric patients with hand and upper limb involvement, with emphasis on the management of loco-regional complications. In terms of importance and frequency, we highlight compartment syndrome, phlyctenas and infections. Methodology: a literature search was carried out in MedLine/PubMed with the keywords: "Snake Bite hand Children" and "Snake Bite compartment syndrome". Articles published in the last 10 years (2012 to 2022) were included. Results: the search for articles with the words "Snake Bite hand Children" resulted in 20 articles and the search for the words "Snake Bite compartment syndrome" resulted in 34 articles. After applying the inclusion and exclusion criteria, 30 articles were obtained for the analysis. Conclusions: the pediatric population is more exposed to snake bites and in turn to present more severe lesions. The treatment of compartment syndrome continues to be a subject of debate. Inoculated venom can simulate a compartment syndrome that can be reversed without fasciotomies with proper treatment. Likewise, in the presence of clear symptoms and signs of compartment syndrome, fasciotomies are suggested because of the serious sequelae generated. In the event of the appearance of phlyctenas, careful unroofing of the phlyctenas would be an appropriate treatment. Most authors agree with prophylactic treatment with antibiotic therapy.

Introdução: O envenenamento por mordidas ofídias é reconhecido como um problema de saúde pública pela Organização Mundial da Saúde. A baixa incidência, juntamente com a diversidade de apresentações clínicas, idades, topografias afetadas, bem como os diferentes protocolos da literatura existente sobre alguns aspectos do tratamento, tornam difícil o gerenciamento sistemático desses pacientes. O objetivo deste trabalho é realizar uma revisão sistemática da literatura sobre mordida de cobra em pacientes pediátricos com envolvimento de mãos e membros superiores, com ênfase no gerenciamento de complicações loco-regionais. Em termos de importância e freqüência, destacamos a síndrome compartimental, as flectenas e as infecções. Metodologia: foi realizada uma pesquisa bibliográfica no MedLine/PubMed com as palavras-chave: "Snake Bite hand Children" e "Snake Bite compartment syndrome". Os artigos publicados nos últimos 10 anos (2012 a 2022) foram incluídos. Resultados: a busca de artigos usando as palavras "Snake Bite hand Children" resultou em 20 artigos e a busca das palavras "Snake Bite compartment syndrome" resultou em 34 artigos. Após a aplicação dos critérios de inclusão e exclusão, foram obtidos 30 artigos para análise. Conclusões: a população pediátrica está mais exposta às picadas de cobra e, por sua vez, a lesões mais graves. O tratamento da síndrome compartimental continua a ser motivo de debate. O veneno inoculado pode simular uma síndrome de compartimento que pode ser revertida sem fasciotomias com tratamento apropriado. Da mesma forma, se houver sinais e sintomas claros de síndrome compartimental, são sugeridas fasciotomias por causa das severas seqüelas. Se as flectenas aparecerem, o desenrolamento cuidadoso das flectenas seria um tratamento apropriado. A maioria dos autores concorda com o tratamento profilático com a antibioticoterapia.

Renal and hepatic changes in a case of envenomation by snake bite: Case report and review of literature

Snake bite is a major health hazard, moreover in tropical countries where the density of snakes, frequent human contact, lack of diagnostic and treatment facilities further add-on to the high morbidity and mortality. No organ escapes the effect of envenomation from Heart to liver and kidney, CNS to local bite site. While the effect of snake venom on kidney has been documented, the literature available on the pathological effects of envenomation in human liver is lacking. We present a case of an elderly male with renal and hepatic manifestations of envenomation.

Epidemiological analysis of 952 venomous snake bite in Wuzhou City of Guangxi Zhuang Autonomous Region / 中华危重病急救医学

Objective:To improve the prevention and treatment of venomous snake bites by analyzing the epidemiological characteristics of venomous snake bite in Wuzhou City, Guangxi Zhuang Autonomous Region.Methods:A retrospective analysis was conducted. The medical records of 1 091 patients with venomous snake bites admitted to the department of snake wound of Wuzhou Hospital of Traditional Chinese Medicine from January 2014 to December 2020 were collected, including snake species, gender and age of patients, bite time, bite site and local symptom.Results:The medical records of 952 patients with a definite clinical diagnosis of snake bite were enrolled. Among the 952 patients with venomous snake bites, the main bites were from Ovophis (32.98%), Trimeresurus (27.84%) and Naja (26.26%), followed by Bungarus multicinctus (6.51%), Ophiophagus Hannah (3.15%) and Agkistrodonhalys (1.58%), and few bites were from Rhabdophis subminiatus (0.73%), Bungarus fasciatus (0.42%), viper (0.32%) and Agkistrodon (0.21%). Of the 952 patients with venomous snake bites, there were almost twice as many males as females [647 cases (67.96%) vs. 305 cases (32.04%), with male to female ratio of 2.12∶1]. The age of patients ranged from 0.8 to 87.0 years old, with 40-59 years old as the majority (42.44%), followed by ≥ 60 years old (27.31%). Snake bites mainly occurred from April to November (93.59%), with a peak in October (16.39%). The incidence time was mainly afternoon (12:00-17:59, 30.88%) and evening (18:00-23:59, 33.30%), followed by morning (06:00-11:59, 24.69%), and early in the morning (00:00-05:59, 11.13%). The incidence time of Ovophis and Bungarus multicinctus mainly concentrated in 18:00-23:59, the time of Trimeresurus was in 06:00-11:59, and that of Naja and Ophiophagus hannah was in 12:00-17:59. Most cases of snake bite were on limbs (98.53%), and mainly on the right limbs (53.57%). The lower limbs mainly were bitten by Ovophis, while the upper limbs mainly were bitten by Naja and by Ophiophagus hannah. The local symptoms of the bite of Ovophis and Trimeresurus were similar, mainly including pain, swelling, tenderness, high temperature of skin around the wound, bleeding and exudation, etc. And the local symptoms of the bite of Naja were pain, swelling, bruising, tenderness, bleeding and exudation, red skin, etc. Numbness and mild pain were the main symptoms of the bite of Bungarus multicinctus and Bungarus fasciatus, but other local characteristics were not obvious.Conclusions:The majority of venomous snake bite patients in Wuzhou City of Guangxi were middle-aged and elderly males, and the majority of venomous snakes were Ovophis, Trimeresurus, and Naja. Most venomous snake bite occurs from April to November, and the incidence time was concentrated between 12:00 and 23:59. The majority of venomous snake bite was limb bites. The local symptoms were pain, swelling, tenderness, high temperature of skin around the wound, bruising, etc. To reduce the incidence rate, disability rate and mortality of snake bite disease, a snake bite prevention system should be established, the education and publicity of snake bite prevention knowledge should be strengthened, the awareness of snake bite prevention should be improved, and clinical diagnosis and treatment should be assisted, based on the epidemiological characteristics of snake bite in Wuzhou area.

Prediction model of early risk of limb infection secondary to trimersurus mucrosquamatus snakebite / 中华急诊医学杂志

Objective:To explore the method of early prediction of the risk of limb infection in patients bitten by trimersurus mucrosquamatus snake. Methods:Totally 108 inpatients with limbs bitten by trimersurus mucrosquamatus snake in Chongqing Emergency Medical Center from January 2019 to October 2020 were respectively collected. They were divided into the infection group (23 cases) and non infection group (85 cases) according to whether they had secondary infection in the course of the disease. The clinical characteristics and serum indexes before admission were compared between the two groups to screen out the risk factors of infection. By combining all the above methods, the risk factor score was screened out; and the prediction model was constructed according to the snake bite severity score (SSS) and appearance score. The differences of the three prediction models between the two groups of patients were compared, and the predictive value of the three prediction models for the risk of limb infection in patients bitten by trimersurus mucrosquamatus snake was evaluated through the receiver operating characteristic (ROC) curve. Results:There were significant differences in clinical characteristics and serum indexes before admission, injury time, hand and foot finger injury, edema score, tension blister, subcutaneous hemorrhage and admission platelet count between the two groups ( P<0.05). The scores of the three predictive models differed between the two groups ( P<0.05). The ROC curve was used to evaluate the predictive value of the three models for the risk of infection in the course of the disease. The predictive AUC value of the risk factors score was 0.830 (95% CI: 0.635-0.850), the cutoff value was 2.5, the sensitivity was 0.870 and the specificity was 0.671, which was the best in the three prediction models. Conclusions:The prediction model based on the risk factors can effectively predict the infection risk of snake bite patients. It indicates that the infection risk is high when the score of risk factors ≥3 points, which can be used as the basis for guiding clinical treatment plan and is worthy of promotion.

Anti-Snake Venom Properties of Medicinal Plants: A Comprehensive Systematic Review of Literature

Abstract Snakebite is one of the major health issues posing considerable morbidity and mortality. According to an estimate of World Health Organization (WHO) (World health organization, 2021) approximately 5 million people are bitten by several species of snakes resulting in up to 2.5 million envenomation cases annually. The mainstay of treatment for envenomation is intravenous administration of anti-snake venom. Although antivenom neutralizes the systemic effects but it does not relieve the symptoms such as venom-induced hemorrhage, necrosis and nephrotoxicity. Moreover, the use of antivenoms is associated with hypersensitivity reactions including urticaria, anaphylaxis, or serum sickness due to their heterologous property. Furthermore, stringent storage conditions and narrow specificity of antivenoms limit their use in both developed as well as developing countries. In this context, researchers have been searching for natural products and plant extracts to explore their antivenom activity along with anti-myotoxic, anti-hemorrhagic and anti-inflammatory properties. Plant remedies may prove to be an effective alternate for antivenom sera with less adverse events and better tolerability. To the best of our knowledge, this is the first comprehensive review of medicinal plants possessing anti-snake venom activities against certain species of snakes. The current review highlights the investigated plants with their phytochemical analysis to integrate the available information for future research and development of antivenom sera.

Synergistic effect of flavonoids combined with antivenom on neutralisation of Naja naja venom

Objective: To evaluate the neutralizing effects of flavonoids on snake venom toxicity by stand-alone and combinatorial approaches. Methods: Synthetic flavonoids were assessed, either individually or in combination with antivenom, for their neutralization of phospholipase A

Snake bite induced delayed hypopituitarism: a rare case report

Hypopituitarism following snake bite induced AKI and dialysis is an uncommon complication. Often the presentation is delayed and Can present with a myriad of features. We present a case of a 27 year old male patient, with past history of snake bite and acute kidney injury (AKI) requiring dialysis and which subsequently resolved, presenting to us with fatigability and weakness, absence of secondary sexual character and poor academic performance. On examination, the patient had pale white and coarse skin. Hoarseness of voice was present. There was proximal upper and lower limb muscle weakness present with pseudo myotonia on examination. There was loss of axillary and pubic hair with low testicular volume. Routine reports suggested mildly elevated creatinine with severely elevated Triglyceride levels. Creatine phosphokinase (CPK) was raised. Hormonal profile revealed low free thyroxine (FT4) and serum 8 a.m. Cortisol but an inadequate increase in thyroid stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH) levels were suggestive of central hypopituitarism. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), Insulin-like growth factor 1 (IGF-1) levels were reduced. Neuroimaging revealed empty sella suggestive of pituitary apoplexy. The above were suggestive of delayed hypopituitarism following post snake bite dialysis mediated pituitary apoplexy. In all cases of snake bite, a common occurrence in our country the possibility of hypopituitarism should be kept in mind and the hormonal profile followed up closely along with the renal parameters.

Tourniquet application in snake bite: are we aware?

Background: To assess the use of tourniquets as mentioned in National Snake Bite Management Protocol among peripheral health care providers.Methods: This was a prospective cross-sectional study conducted in a tertiary care institute between June 2016 to June 2017. A total of 36 patients of snake bite referred from peripheral health facility were enrolled in the study and were evaluated for : date and time of bite, site of bite, weather snake was seen, type of envenomation, first aid given in Govt facility/alternative practitioner, tourniquet applied/not applied, anti snake venom given/not given as first aid and outcome.Results: The mean age of the study population was 39 years (17.38) range 18 years to 75 years. 18 patients were male and 18 were female. 30 (83.3%) patients had site of bite over the extremities’. The venom was hemotoxic in 12 (33.3%) patients and neurotoxic 21 (58.3%). 30 (83.3%) patients  received first aid in the Government health facility  manned by qualified in healthcare practitioner and 6 (16.7%) were treated by traditional healers. 29 (80.6%) patients had a tight tourniquet tied to the site of the bite when seen in emergency department of institute. None of the patients had their limbs splinted. 31 (86.1%) patients had received anti snake venom (ASV) at the peripheral health facility. The mortality rate was 5.6% with only 2 deaths.Conclusions: The majority of peripheral health care providers both qualified and unqualified use tourniquets in patients suffering with snake bite. The peripheral health care providers are not aware of importance of limb splinting and immobilisation. Though the rate of instilling ASV is good, the health care providers in the peripheral institutes should be made aware of recommendations of national snake bite management protocol with regard to use of tourniquets and limb splitting in snake bite patients.

A comparative study in the outcome between the two fixed doses of polyvalent anti snake venom, 10 vials versus 20 vials, with mechanical ventilation in children with severe neurotoxic snake envenomation

Background: Every year about 50,000, people die of snake bites in India. Anti-snake venom and mechanical ventilation is mainstay of treatment in cases with severe neurotoxic envenomation. ASV is costly and scarce resource. There is lack of universal consensus towards the optimal dose of ASV in management protocol for children with severe neurotoxic snake envenomation. Objective was to compare the difference in outcome between two fixed doses of ASV, 10vials versus 20 vials, in children with severe neurotoxic snake envenomationMethods: This comparative observational study was carried out for a period of 3 years in Department of Pediatrics of SVS Medical College, Mahabubnagar, Telangana, India. Children with history of snake bite and clinical evidence of neuroparalysis were included. In addition to the mechanical ventilation and other supportive measures, every alternate patient was administered with 10vials (low dose) and 20 vials (high dose) of ASV over 1 hour. Outcome was compared between the two groups.Results: Of the 62 patients, 32 were in each group. The median time to extubation was 41 hours and 39.5 hours and mean duration of the hospital stay was 4.6 days and 4.5 days among the low dose and high dose groups, respectively. There were three deaths, one from low dose group and two from high dose group.Conclusions: There was no significant difference in outcome between the 10 vials vs 20 vials of ASV in addition to mechanical ventilation in treatment of children with severe neurotoxic snake envenomation. So, 10 vials of ASV can be utilized to reduce the cost of treatment.

Snake bite, a neglected menace: a prospective observational study in a tertiary care pediatric intensive care unit

Background: Snake bite is a neglected and underestimated public health problem in tropical and subtropical region. Snake envenomation is a well-known cause of morbidity and mortality in India. In 2009, WHO declared snake bite a neglected disease. Ophitoxaemia is an exotic term characterising the clinical spectrum of snake bite. Objective of this study was to know the outcome in paediatric snake bite cases in a tertiary care PICU (Paediatric Intensive Care Unit) with special reference to envenomation time and also to evaluate and analyse few atypical presentations of snake envenomation by proper history taking, physical examination and help start early intervention to prevent morbidity and mortality.Methods: A prospective observational study was done in Paediatric Intensive care unit of the hospital from June 2017 to June 2019.Results: Around 56.8% of 109 cases were non-poisonous snake-bites. Out of 47 cases admitted to PICU, 68.08% developed cellulitis at the site of bite with Staphylococcus aureus being the commonest organism isolated (56.25%). Anaerobes (bacteroides and clostridium) were also isolated in few cases. Edema at site of bite (hematotoxic) and ptosis(neurotoxic) were most common initial presentation. 36.17% of patients received ASV (Anti- Snake Venom) and first aid within 6 hours of snake bite. The morbidity and mortality were significantly less (p<0.05) as compared to those who didn't receive ASV. 12.76% of cases with normal CRT (Clot Retraction Time) presented with features of coagulopathy. DIC (58.33% of hematotoxic bites) and respiratory paralysis 68 (75% of neurotoxic bites) were the commonest complications. Renal replacement therapy was required in 6.38%, transfusion in 10.63% cases and case-fatality-rate was 12.7%. There were a few atypical presentations of snake bite mimicking Gullain-Barre syndrome, acute onset encephalitis with absent brainstem and pupillary reflexes, intracerebral hemorrhage and cortical blindness.Conclusions: Most snake bites are non-poisonous. Early first aid and ASV administration has better outcome. Fibrinogen levels are more reliable than CRT to diagnose coagulopathy. Acute presentations i.e, altered sensorium, paralysis, blindness and stroke like features should always be evaluated for snake envenomation in suspected cases to prevent morbidity and mortality.

Clinico-Epidemiological Profile and Outcome of Snake Bite Cases Admitted in a Tertiary Care Centre in South India

Snake bite is an important life-threatening emergency but often neglected public health problem in India. India being a subtropical country, has been a land of poisonous snakes, especially in Southern India poisonous snakes like Russell’s Viper, Cobra, Krait and Saw Scaled Viper are commonly encountered. In India around 50,000 people are dying every year from snake bites. In spite of these, the true scale of mortality and morbidity from snakebite remains uncertain. We wanted to study the pattern of envenomation and dry bite among the snake bite cases admitted in Government Vellore Medical College Hospital for the period Jan 2018- Jan 2019, describe the clinicoepidemiological profile and outcome of snake bite cases. We also wanted to evaluate the predictive factors of mortality among snakebite cases admitted in a tertiary care centre in Vellore, South India.METHODSA retrospective descriptive analysis of data extracted from medical records of 522 snakebite cases admitted in the Medical wards and IMCU at Government Vellore Medical College and Hospital, Vellore, Tamil Nadu, during the period extending from January 2018 to January 2019 was done, to describe Clinico –epidemiological profile and management of snake bite cases. We described age/gender distribution, seasonal trends of snake bite cases. We computed proportion of envenomation, dry bite and case fatality rate. Among envenomation we analysed the trends in antisnake venom (ASV) usage and its clinical outcome. Statistical analysis was done using Epi Info – Version 7.2 software.RESULTSOf the total 522 snake bite cases admitted in the hospital during the period from Jan 2018 to Jan. 2019, it was found that the median age of the snake bite victim was 40 years (range 13-76). Snakebite cases were higher among male (56%), agriculture worker (47%), rural population (92%) and during monsoon July-October (65%). Sixty percent of the bites occurred in ankle and foot. Species of snake was identified in 23 (4%) cases. The proportion of dry bite and envenomation were 46% and 54% respectively. Of the envenomation cases 20% were haemotoxic, 24% were neurotoxic and 10% were local envenomation. The median duration of hospital stay among envenomation cases was 4 (range 1-20 ) days and interval between bite and ASV administration was 4 (range 1-48) hours. Sixty cases (13%) were allergic to ASV. Case fatality was 2.5 %( 13/522).CONCLUSIONSEffective management of snakebites would include early admission to a hospital, appropriate ASV administration and early identification of the warning signs. Delay in hospitalization is associated with poor prognosis and increased mortality rate due to consumptive coagulopathy, renal failure and respiratory failure.

Clinical Profile of Snake Envenomation with Complications and Outcome in a Tertiary Health Care Centre, Kalburgi.

Bites by snakes represent an important health problem in the tropical world including India. The true incidence of snakebites is difficult to assess and often is under reported. Though the exact number of snake bites is unknown, an estimated 5.4 million people are bitten each year with up to 2.7 million envenoming. Around 81,000 to 1,38,000 people die each year because of snake bites, and around three times as many amputations and other permanent disabilities are caused by snakebites annually. We wanted to determine frequency of various modes of presentation, complications and management of snakebite.METHODSAll patients presenting to emergency department of Basaveshwara Teaching and General Hospital with history of snakebite and features of envenomation were included in the study. All these patients were given Anti-Snake Venom. Symptomatic treatment of complications was done. Semi-structured questionnaire was filled during hospital stay to analyse various characteristics of snakebite and people’s attitude towards this problem.RESULTS75 cases of snakebite admitted to Basaveshwara Teaching & General Hospital, Gulbarga between January 2018 to November 2019 were studied. Males [50 (62.5%)] were affected more than females [25 (31.5%)] in the ratio of 2:1. Most common age group is 20-40 years [45 (60%)]. Snakebite is a common health hazard in rural areas [55 (73.34%)]. Agricultural labourers (68.6%) are the major sufferers with majority of bites occurring outdoor 60 (80%). 71 (94.66%) bites occurred over limbs, out of which 38 (50.66%) were in lower limbs. Most bites occur between 12 Noon to 12 Midnight 60 patients (81.2%). Out of 75 patients, 60 (80%) were poisonous snakebites, 20 (20%) were non-poisonous snakebites. Among 60 (80%) poisonous bites, 32 (53.34%) had neurotoxic manifestations and 28 (46.66%) had hemotoxic manifestations.CONCLUSIONSSnakebite is common in rural setup, in agricultural labourers. Most common victims are males in the age group between 20-40 years. Poisonous bites were more common than non-poisonous snake bites in this study. In neurotoxic envenomation ptosis was the commonest and earliest symptom while in hemotoxic envenomation, most common symptoms were bleeding from bite site and hematuria. The commonest complications were acute renal failure and respiratory paralysis. Shock, infection and gangrene were also noted in some patients. Maximum mortality was observed in patients who were admitted after 24 hours. Early hospitalization and timely ASV administration were the corner stones in the treatment of snakebite.

Snakebites in Rio Branco and surrounding region, Acre, Western Brazilian Amazon

Abstract INTRODUCTION Snakebites are considered a neglected tropical disease in many countries in Latin America, including Brazil. As few studies have assessed snakebites in the Amazon region and especially in the state of Acre, epidemiological studies are of great importance. The present study aimed to describe the epidemiological characteristics of snakebites in the Rio Branco region, observing their characteristics in rural and urban areas and their correlation with rainfall and river outflow. METHODS This retrospective, descriptive study analyzed epidemiological information obtained from snakebite notifications registered on the Information System for Notifiable Diseases that occurred from March, 2018 to February, 2019. The cases of snakebite were correlated with rainfall and flow. RESULTS A total of 165 cases of snakebite were registered in the period. Most cases were caused by Bothrops and affected mainly individuals of the male sex who were between 21 and 30 years old. Most of the snakebites occurred in Rio Branco (71.52%; 29 cases per 100,000 inhabitants). Of these, 60.2% occurred in the urban area and 39.8% in the rural area and the majority occurred during the rainy season. CONCLUSIONS Although studies have shown that a majority of cases occur in rural areas, in this study, urbanization of snakebites was observed. The Bothrops genus was responsible for the highest number of snakebites and, during the rainy season, bites occurred more frequently. Educational prevention campaigns, population advice, and first aid in case of snakebites for the population are thus suggested.

Neutralizing potential of Rauvolfia serpentina root extract against Naja naja venom

Snake bites are a serious health hazard occurs throughout the world especially in tropical countries like India. Anti-Snake Venom Serum is the only remedy available to treat snake bite victims successfully till date. Infusion of ASV may lead to adverse reactions ranging from severe itching of the skin, hives to potentially serious allergic reactions. Considering all above difficulties research workers all over the world is constantly in search of a cheap and readily available easy formulate remedy for treating snake bite victims. In present study aqueous extract of Rauvolfia serpentina root was checked for the antidote properties against Naja naja venom by in vitro and in vivo methods. Various in vitro neutralization tests like Acetyl cholinesterase, Protease and ATPase activity of Naja naja venom were carried out and the root extract was neutralized all the toxic effects induced by the venom. The in vivo assessment of venom lethality (LD50) of Naja naja venom was found to be 0.301 µg. The aqueous root extract was effectively neutralized the venom lethality and effective dose (ED50) was found to be 12.88 mg/ 3LD50 of Naja naja venom. LC-MS analysis from root extract of Rauvolfia serpentina was done for confirmation of the bioactive compounds.

Snake Bite Victim Treatment Outcome In Tertiary Care Setting In Kumaon Region Of Uttarakhand

Background: Kumaon region of Uttarakhand has a wide array of snakes. According to national health profile 2016 report on state wise cases and death due to snake bite was 167 and 1 respectively in Uttarakhand 2015 (Jan- December).This led to enquire this statistical disparity in spite of high prevalence of snake bite cases. Aim: To asses treatment outcome of Snake bite victim in tertiary care setting. Material And methods: Outcome was assessed in terms of clinical status at the time of discharge and duration of hospitalization. Results: Dose range of anti snake venom (ASV) for all snake bite victim was 10 -20 vials. 86.36%% case recovered and 13.6% died. Conclusion:Timely appropriate dose of anti snake venom administration has led to better outcome for which transportation of snake bite victim to appropriate health facility with in golden hour is imperative.

Clinical profile and prognostic indicators of neurotoxic snake bite in rural India

Background: In rural India, snakebite is an occupational and environmental hazard. WHO listed snakebite as one of the neglected tropical diseases and in rural India it is underreported because of popular traditional methods of treatments and lack of healthcare facilities. This study is an attempt to look into the epidemiological, clinical and prognostic indicators of neurotoxic snake bite in rural India.Methods: This study is a prospective, descriptive study of 25 neurotoxic snake bites admitted in our hospital from January to September 2019. Clinical factors like age, sex, clinical features, management and the outcome of patients are studied.Results: Young males were common victims of snakebite in evening hours during monsoon season. All patients received traditional methods of treatment, and despite this 64% of our patients reported to the hospital within 6 hours after the bite. Overall, the mortality rate in this study was 12%. Poor outcome was also noted in cases who were having respiratory failure and needed artificial ventilation (30%). Mortality was 22.2% in patients where bite to admission time was greater than 6 hours as compared to 6.25% in patients where it was less than 6 hours.Conclusions: Author concluded that a neurotoxic snake bite is a life-threatening emergency. In preventive measures, outdoor activities in dim lights during monsoon season should be restricted. Traditional treatments are still popular and trusted methods of treatment in rural India and these healers can be educated to recognize and refer immediately all neurotoxic bites to nearby medical facilities.

A study to assess the clinical profile of patients with snake bites in a tertiary care hospital

Background: Snakebite is a life-threatening medical emergency. It occurs frequently among rural people, especially those working in the fields. Most houses in rural areas of India are made of mud and have many crevices where rodents flourish. Delay in seeking medical aid or ignorance among primary care physicians about the correct treatment of snakebite is responsible for the high morbidity and mortality. Authors objective was to study the clinical profile of snake bite at a rural tertiary care centre.Methods: A hospital based cross sectional study was conducted at M S Rammaih Medical College Bangalore from June 2017 to June 2018. The incidence of Snake bite in Karnataka is 0.5% and at 95% confidence interval with Margin of error at 1% the estimated sample size was 197, but in this study author were able to collect data of 237 cases, hence all the cases were included in the study and analyzed.Results: Majority of the respondents were middle aged between 21-50 years. Around 63.3% of the respondents were male and nearly 56.2% were farmers. The incidence of snake bite of Cobra was seen in 8.9%, Krait 5.1% and viper 4.2%. Around 70% patients had no significant complications following hospitalization in our study. Around 20% had hematotoxic like ARF, DIC and local gangrene.Conclusions: Snakebite is one of the common hazards especially in rural setup as agriculture being the main occupation. Snake bite can present with various manifestations at bite sites, neurotoxicity, hematotoxicity.