Accidente ofídico como problema de salud pública serpientes en la ciudad / Ophidian accident as a public health problem snakes in the city

En todo el planeta ocurren mordeduras por serpiente tanto en humanos, como animales; sin embargo, muchos pueblos carecen de recursos para prestar atención sanitaria, administrar suero antiofídico o mantener seguimiento desde lo multidisciplinario al paciente que quedó con secuelas. Objetivo: Establecer alertas tempranas sobre migración o emigración de serpientes hacia la ciudad, respecto al accidente ofídico como problema de salud pública. Materiales y métodos: La investigación es monográfica de tipo documental y muestra pertinencia social. Resultados: Es indispensable abordar tempranamente a la víctima, así como, registrar causas coadyuvantes o desencadenantes del accidente, ya que, dejó de ser exclusivamente rural y se registra en zonas urbanizadas e incluso en la ciudad. El alcance y magnitud de la investigación, sobrepasa lo académico de fortalecer áreas de conocimiento en carreras científicas del pregrado y trasciende a carreras relacionadas, afines y de postgrado, relacionadas indirectamente al problema. Conclusión: Garantizar seguridad del humano y su entorno requiere disposición para la prevención; no obstante, la migración o emigración de ésta biodiversidad revela un problema socio-ambiental, dependiente de entender la gestión académica y alertas tempranas que anuncian que, las serpientes han llegado a la ciudad(AU)

All over the planet snake bites occur in both humans and animals; however, many towns lack the resources to provide health care, administer antivenom serum or maintain multidisciplinary follow-up of the patient with sequelae. Objective: To establish early alerts on the migration or emigration of snakes to the city, regarding the ophidian accident as a public health problem. Materials and methods: The research is monographic documentary type and shows social relevance. Results: It is essential to address the victim early, as well as to record contributing causes or triggers of the accident, since it is no longer exclusively rural and is recorded in urbanized areas and even in the city. The scope and magnitude of the research goes beyond the academic of strengthening areas of knowledge in undergraduate scientific careers and transcends related, related and postgraduate careers, indirectly related to the problem. Conclusion: Ensuring the safety of humans and their environment requires provision for prevention; however, the migration or emigration of this biodiversity reveals a socio-environmental problem, dependent on understanding the academic management and early warnings that announce that the snakes have arrived in the city(AU)

Ofidismo no Tocantins: análise ecológica de determinantes e áreas de risco, 2007-2015 / Ofidismo en Tocantins: análisis ecológico de determinantes y áreas de riesgo, 2007- 2015 / Snakebite in Tocantins: ecological analysis of determinants and risk areas, 2007- 2015

Objetivo: Investigar o perfil dos casos de acidentes ofídicos, seus determinantes e áreas de risco no estado do Tocantins. Métodos: Estudo ecológico, com dados do Sistema de Informação de Agravos de Notificação do período 2007-2015. Empregou-se regressão linear múltipla e os testes Mann-Whitney e Kruskal-Wallis. Resultados: Foram notificados 7.764 acidentes ofídicos (incidência de 62,1/100 mil habitantes; letalidade de 0,5%). As variáveis associadas ao ofidismo foram densidade demográfica (Coef.=1,36 - IC95% 0,72;1,99), trabalho agropecuário (Coef.=0,02 - IC95% 0,01;0,03), índice de desenvolvimento humano municipal (Coef.=2,99 - IC95% 0,60;5,38), área cultivada de mandioca (Coef.=8,49 - IC95% 1,66;15,32), população indígena (Coef.=0,02 - IC95% 0,00;0,04), proporção de população analfabeta (Coef.=4,70 - IC95% 0,61;8,79) e população empregada (Coef.=3,00 - IC95% 0,93;5,06), que explicaram 64,48% da variação. As áreas de alto risco foram as regiões de saúde Amor Perfeito, Cantão, Cerrado Tocantins Araguaia e Médio Norte Araguaia. Conclusão: Aspectos socioeconômicos e demográficos municipais associaram-se ao ofidismo.

Objetivo: Investigar el perfil de accidentes ofídicos, sus determinantes y áreas de riesgo, en el estado de Tocantins. Métodos: Estudio ecológico con datos del Sistema de Información de Enfermedades de Agravamiento de Notificación, 2007-2015. Se utilizaron pruebas de regresión lineal y pruebas de Mann-Whitney y Kruskal-Wallis. Resultados: Se reportaron 7.764 accidentes ofídicos (incidencia: 62,1/100.000 hab.; letalidad: 0,5%). Las variables relacionadas al ofidismo fueron densidad demográfica (Coef.=1,36 - IC95% 0,72;1,99), trabajo agrícola (Coef.=0,02 - IC95% 0,01;0,03), índice de desarrollo humano municipal (Coef.=2,99 - IC95% 0,60;5,38), área cultivada de yuca (Coef.=8,49 - IC95% 1,66;15,32), población indígena (Coef.=0,02 - IC95% 0,00;0,04), proporción de la población analfabeta (Coef.=4,70 - IC95% 0,61;8,79) y empleados (Coef.=3,00 - IC95% 0,93;5,06), explicando 64,48% de la variación. Las áreas de alto riesgo fueron las regiones de salud Amor Perfecto, Cantão, Cerrado Tocantins Araguaia y Medio Norte Araguaia. Conclusión: Aspectos socioeconómicos y demográficos municipales se asociaron con el ofidismo.

Objective: To investigate the epidemiological profile of snakebite accident cases, their determinants and risk areas in the state of Tocantins. Methods: This was an ecological study using data from the Notifiable Health Conditions Information System, from 2007 to 2015. Multiple linear regression and the Mann-Whitney and Kruskal-Wallis tests were used. Results: A total of 7,764 snakebite accidents were reported (incidence: 62.1/100,000 inhab.; lethality: 0.5%). The variables associated with snakebite were population density (Coeff.=1.36, 95%CI 0.72;1.99), farming work (Coeff.=0.02, 95%CI 0.01;0.03), municipal human development index (Coeff.=2.99 - 95%CI 0.60;5.38), area planted with cassava (Coeff.=8.49 - 95%CI 1.66;15.32), indigenous population (Coeff.=0,02 - 95%CI 0.00; 0.04), proportion of illiterate people (Coeff.=4.70 - 95%CI 0.61;8.79) and employed people (Coeff.=3.00 - 95%CI 0.93;5,06), which together accounted for 64.48% of the variation. The high-risk areas were Amor Perfect, Cantão, Cerrado Tocantins Araguaia and Mid-North Araguaia health regions. Conclusion: Municipal socioeconomic and demographic aspects were associated with snakebites.

Envenenamientos por mordedura de serpiente en Guatemala: revisión de literatura / Snakebite envenomings in Guatemala: literature review

El accidente ofídico es una enfermedad tropical desatendida que ocasiona un problema de salud pública en el mundo, siendo una de las principales causas de morbilidad y mortalidad en las áreas empobrecidas de América Latina. En Guatemala se distribuyen 23 especies de serpientes venenosas de importancia médica. La composición de los venenos es compleja y diversa, resultando en una variedad de manifestaciones clínicas. Los departamentos con mayor incidencia de ofidismo son Petén, Alta Verapaz, Quiché, Escuintla e Izabal. Estos accidentes afectan más a hombres que a mujeres, siendo la mayoría agricultores; el rango de edad más comprometido es de 10-19 años y principalmente ocurren en miembros inferiores. El tiempo medio que tarda la víctima en llegar al hospital es de 5.6 h, siendo el retraso en la atención médica, un factor de riesgo para severidad y mortalidad. Los servicios de salud en ocasiones no cuentan con recursos idóneos para atender a las víctimas, brindando tratamiento sintomático. Simultáneamente, el tratamiento empírico tiene gran aceptación, sin embargo, los resultados de investigaciones realizadas con algunas plantas de uso común en casos de ofidismo, concluyeron que no es recomendable su uso aislado en el tratamiento del envenenamiento. Dada la falta de información se debe promover más investigación sobre el ofidismo en el país, siendo indispensable la elaboración de una ficha de reporte obligatoria. Además, deben elaborarse guías de tratamiento e identificación de serpientes para uso del personal médico, incluyendo programas de educación a nivel comunitario.

Snakebite envenoming is a neglected tropical disease that causes a public health problem in the world, being one of the main causes of morbidity and mortality in impoverished areas of Latin America. 23 species of poi-sonous snakes of medical importance are distributed in Guatemala. The composition of venoms is complex and diverse, resulting in a variety of clinical manifestations. The departments with the highest incidence of snakebites are Petén, Alta Verapaz, Quiché, Escuintla and Izabal. These accidents affect more men than women, the majo-rity being farmers; the most compromised age range is 10-19 years and they mainly occur in the lower limbs. The average time it takes for the victim to reach the hospital is 5.6 hours, with delay in medical care being a risk factor for severity and mortality. Health services sometimes do not have adequate resources to care for victims, providing symptomatic treatment. Simultaneously, empirical treatment is widely accepted, however, the results of research carried out with some plants commonly used in cases of envenoming concluded that their isolated use is not recommended in the treatment. Given the lack of information, more research on snakebite envenoming in the country should be promoted, making the preparation of a mandatory report form essential. In addition, snake identification and treatment guides should be developed for use by medical personnel, including education pro-grams at the community level.

Epidemiology of snakebites in Kédougou region (eastern Senegal): comparison of various methods for assessment of incidence and mortality

Although considered a public health issue in Senegal, the actual incidence and mortality from snakebite are not known. In the present study, an epidemiological survey was carried out in Kédougou region, southeastern Senegal, where envenomations, particularly by Echisocellatus, are frequent and severe. Methods Three sources of data were used: records from health centers and reports by health professionals; traditional healers; and household surveys. Results The annual incidence and mortality provided by health centers were 24.4 envenomations and 0.24 deaths per 100,000 population, respectively. The annual incidence recorded by traditional healers was 250 bites per 100,000 inhabitants, but the number of deaths was unknown. Finally, the household surveys reported an annual incidence of 92.8 bites per 100,000 inhabitants and an annual mortality rate of 2.2 deaths per 100,000 inhabitants. The differences in incidence and mortality between the different methods were explained by significant bias, resulting in particular from the complex patient's healthcare-seeking behavior. The incidence provided by health records should be used to specify the immediate quantitative requirements of antivenoms and places where they should be available first. Conclusion Mandatory reporting of cases would improve the management of envenomation by simplifying epidemiological surveys. Patients' preference for traditional medicine should prompt health authorities to urge traditional healers to refer patients to health centers according to defined clinical criteria (mainly edema and bleeding or neurotoxic symptoms). Finally, household surveys were likely to reflect the actual epidemiological situation. Poison Control Center of Senegal should continue its work to sensitize stakeholders and train health staff.

Evaluación de la capacidad neutralizante de extractos de plantas de uso popular en Guatemala como antídotos para el envenenamiento por la mordedura de Bothrops asper / Neutralizing activities of ethanolic extracts of six plants traditionally used in Guatemala as antidotes for the envenomation caused by the snake Bothrops asper

Se determinó la capacidad de los extractos de seis plantas de uso etnomédico (Acacia hindsii, Aristolochia maxima, Cissampelos pareira, Hamelia patens, Piper peltatum y Sansevieria hyacinthoides) para neutralizar los efectos proteolítico y fosfolipasa A2 (PLA2) del veneno de Bothrops asper, la principal especie causante de envenenamiento en el país. Estos efectos, indicadores de la capacidad miotóxica, hemorrágica e inflamatoria del veneno, se evaluaron en ensayos controlados in vitro. Las plantas fueroncolectadas, secadas y extraídas por percolación con etanol. Los resultados demuestran que ninguno de los extractos posee actividad PLA2 o proteo-lítica intrínseca a las dosis estudiadas. Se determinó que tres de los extractos neutralizaron pobremente (< 50%) los efectos estudiados: S. hyacinthoides neutralizó 13.90 ± 6.41% del efecto PLA2 y P. peltatum y C. pareira el 32.98 ± 5.51% y 24.52 ± 7.45%, respectivamente, del efecto proteolítico. Por ello, ningún extracto se evaluó en pruebas de neutralización de la letalidad en ratones. Se concluye que no es recomendable el uso aislado de estas plantas en el tratamiento del envenenamiento por mordedura de B. asper, aunque posiblemente las que demostraron alguna actividad puedan resultar potenciadas al usarse en combinación con otras plantas, como se hace en las recetas tradicionales. Dada la complejidad de los componentes del veneno y sus efectos fisiopatológicos, falta investigar la capacidad de las plantas estudiadas para neutralizar las coagulopatías, edema y miotoxicidad producidas durante el envenenamiento.

Many plants are reported to be used in Guatemalan traditional medicine as antidotes against various effects of the snakebite; however, very few attempts have been made to evaluate their neutralizing capacity in controlled experiments. Six plants (Acacia hindsii, Cissampelos pareira; Hamelia patens, Piper peltatum, Sansevieria hyacinthoides and Aristolochia maxima) were evaluated in vitro for their ability to neutralize phospholipase A2 (PLA2) and proteolytic effects of the venom of Bothrops asper, the snake responsible for approximately half of the snakebite envenomations in Central America. These effects are indicatives of the ability of B. asper venom to produce myotoxicity, hemorrhage and inflammation. Plants were collected, dried and extracted by maceration with ethanol. After pre-incubation of several amounts of each extract with a challenge dose of venom, S. hyacinthoides demonstrated a low neutralizing capacity (< DE 50) of the PLA2 effect (13.90 ± 6.41%); C. pareira (32.98 ± 5.51%) and P. peltatum (24.52 ± 7.45%) neutralized less than 50% of the proteolytic effect. The results suggest that neither of the tested plants should be used individually to treat the main effects of B. asperenvenomation. However, the three low-active extracts might be potentiated when used in mixtures composed of several plants, as prepared by traditional healers. Given the complexity of the venom components and the multiple pathologic effects produced by B. asper envenomation, more tests are required to fully investigate the ability of this plants to neutralize the coagulant, fibrin(ogen)olytic, edematizing and myotoxic effects of the venom.

Ética sobre el envenenamiento ofídico en el paisaje agrario de Guatemala / Ethics of snakebite envenoming in agrarian landscapes of Guatemala

El envenenamiento ofídico es una enfermedad accidental, no infecciosa o contagiosa, causada por los efectos de los venenos de serpientes de las familias Viperidae, Elapidae y Colubridae. Esta enfermedad representa un problema de salud pública a nivel mundial, afectando principalmente a los trabajadores agrícolas. A pesar de derivarse de una relación ecológica antagónica natural entre humanos y serpientes el accidente ofídico es moralmente juzgado como algo malo. En tal sentido, el examen de esta relación supone un componente ético. En el presente ensayo se discute cuál es el significado moral de las serpientes venenosas bajo las perspectivas antropocentrista y biocentrista. Se abordan los temas de riesgo ocupacional y vulnerabilidad del trabajador agrícola a la enfermedad, se elabora sobre las causas de la desatención de esta enfermedad y se reflexiona sobre cuál es la responsabilidad ética del estado, del empresario y del consumidor, en la existencia de ésta enfermedad. Finalmente se discute el papel de la epidemiología social, como una herramienta generadora de información útil para la comprensión de la realidad multidimensional del envenenamiento ofídico.

Snakebite envenoming is an accidental, non-infectious, non-contagious disease, caused by the effects of snake venoms. This disease is a relevant worldwide public health problem in tropical countries. Agricultural workers are highly exposed and therefore, commonly affected. The occurrence of snake envenoming involves some ethics concerns. In this assay, the moral significance of venomous snakes under anthropocentric and biocentric perspectives is discussed. Occupational risk and vulnerability of agricultural workers are also addressed. The ethical roles of government, agricultural enterprises and consumers in the occurrence of the disease are analyzed to try to explain why snakebite envenoming is a neglected disease. Finally, the role of the emerging social epidemiology as the contributor factor to gain involvement of stakeholders ‒which should be responsible for mitigation, prevention, treatment and control of snakebite envenoming‒ is discussed.

Complicaciones neurológicas relacionada con la mordedura de serpiente venenosa: reporte de un caso clínico / Neurological complications related to a venomous snake bites: A Case Report

La mordedura de serpiente venenosa es una condición de emergencia pediátrica, que predomina en países tropicales y subdesarrollados, afecta a millones de personas a nivel mundial, produciendo alta morbilidad y mortalidad. Las complicaciones neurológicas pueden ser producidas por efecto de neurotoxinas o por alteraciones en la cascada de coagulación. Se presenta caso de un adolescente mordido por una serpiente barba amarilla que no recibió tratamiento oportuno y manifestó desde las primeras 48 horas, alteraciones hematológicas y a partir del cuarto día de evolución presentó signos de encefalopatía. Posteriormente se analiza el mecanismo mediante el cual se produjeron estos eventos...(AU)

Krait bite poisoning in manipal region of Southern India.

Krait commonly inhabits the South Asian countries and is regarded as the most dangerous species of venomous snake in the Indian subcontinent. This prospective research included the consecutive cases of Krait bite cases admitted to Kasturba Hospital, Manipal during August 2003 and November 2005. All the victims of Krait bite were females aged between 17 and 35 years. Victims were from a rural background and most of them were bitten indoors and during the night time. Most of the bites involved the lower limbs. Signs of envenomation (neurological symptoms) were observed in 50% of the cases. In the only case of fatal outcome in our study, there was a delay in diagnosis of Krait bite owing to the absence of bite marks. The case emphasizes on the fact that the possibility of snake bite should be considered in an otherwise healthy person who presents with sudden onset of neuroparalytic features.

Envenenamento experimental por bothropoides jararaca e bothrops jararacussu em ovinos: aspectos clínico-patológicos e laboratoriais / Experimental poisoning by bothropoides jararaca and bothrops jararacussu in sheep: clinic-pathological and laboratory aspects

Esse estudo teve como objetivo determinar as alterações clínico-patológicas e laboratoriais em ovinos inoculados com a peçonha de Bothropoides jararaca e Bothrops jararacussu, no intuito de fornecer subsídios que possam facilitar o estabelecimento do diagnóstico e do diagnóstico diferencial dessa condição. Os venenos liofilizados foram diluídos em 1 ml de solução fisiológica e administrados a quatro ovinos por via subcutânea. Três ovinos foram a óbito e um que recebeu a dose de 0,5mg/kg (B. jararaca), recuperou-se. Os sinais clínicos tiveram início entre 7 minutos e 1 hora. O período de evolução variou de 7 horas 9 minutos a 21 horas 59 minutos. O quadro clínico, independentemente das doses, caracterizou-se por aumento de volume no local da inoculação, tempo de sangramento e de preenchimento capilar aumentados, taquicardia, dispnéia, mucosas hipocoradas e apatia. Os exames laboratoriais revelaram acentuada anemia normocítica normocrômica, trombocitopenia, acentuada redução de fibrinogênio e proteínas plasmáticas totais, hematócrito diminuído em dois animais, além de acentuado aumento de creatinaquinase e desidrogenase lática em todos os animais. À necropsia, os principais achados no local da inoculação e tecidos adjacentes eram extensas hemorragias no animal que recebeu o veneno de B. jararaca e edema e acentuado edema pulmonar agudo para os dois animais envenenados por B. jararacussu. Além de hemorragia e edema a principal alteração histopatológica verificada foi necrose das fibras musculares e de vasos, no local de inoculação e adjacências. A necrose tubular renal foi atribuída ao quadro de choque. Nos ovinos deste estudo, o aumento de volume observado no local de inoculação e adjacências era constituído predominantemente por sangue (B. jararaca) e por edema (B. jararacussu).

The purpose of this study was to establish the clinic-pathological and laboratory changes in sheep inoculated with Bothropoides jararaca and Bothrops jararacussu venom to provide subsidies for the differential diagnosis of snake bites. The liofilized venoms were diluted in 1 ml saline and administrated subcutaneously to four sheep. Three of the animals died, and the one that received 0.5mg/kg (B. jararaca venom) recovered. First symptoms were observed from 7 minutes to 1 hour after inoculation, and the clinical course varied from 7 hours and 9 minutes to 21 hours and 59 minutes. The symptoms, independent of the dosage, were swelling of the inoculation site, increased bleeding time and capillary filling, tachycardia, dyspnea, pale mucous membranes and diminished reaction to external stimuli. Laboratory tests revealed pronounced normocytic and normochromic anemia, trombocytopenia, slight reduction of fibrogen and total plasmatic protein, in two animals diminished hematocrit, besides pronounced increase of creatinaquinase and lactic dehydrogenase. At necropsy, the main findings at the inoculation site and adjacent tissues were extensive hemorrhages in the sheep inoculated with jararaca venom, and predominantly edema in the two animals inoculated with jararacussu venom. In two sheep which received jararacussu venom, acute pulmonary edema was observed. Hemorrhage and edema as the main histopathological changes, besides necrosis of muscle fibers and vessels at the inoculation site and adjacent tissue was observed. The renal tubular necrosis was attributed to shock. The volume increase at the inoculation site and surroundings was mainly due to hemorrhage (B. jararaca) or edema (B. jararacussu).

Pattern of renal pathology in fatal envenomation by indian cobra (naja naja).

Deaths due to poisonous snakebite are a significant health related problem especially the rural heartland of in tropical countries. Renal involvement in snakebite is well documented especially so in bites by the Viperidae group. The Elapidae family consisting of cobra and kraits among other varieties are mainly considered neurotoxic. The venom of neurotoxic variety predominantly has direct depressing action on the respiratory center and neuromuscular junction. We investigated the renal changes at autopsy and histology of fatal cobra bites. This series included autopsy examination of 14 cases of fatal cobra bite in our hospital-based study. Dissected kidneys were sectioned, stained with hematoxylin & eosin stain and histological examination was done under light microscope. Five cases from head injury subject were used as control. The study reveals renal involvement in 64.28 %of fatal bites by Indian cobra (Naja naja) primarily considered neurotoxic. The major renal changes were tubular necrosis 1(7.14%), cortical necrosis 3 (21.42%) and interstitial nephritis 3(21.42%). This fact is worth giving due consideration during management and monitoring of cases of envenomation by cobra.

Renal pathological changes in poisonous snake bite.

There are more than 3000 species of snakes in the world but only about 350 are venomous. With approximately 10000 deaths occurring annually in India, a large proportion of snake bites occur when people work barefoot in the fields or while walking at night or early morning through fields or along roads. Although, nearly all snakes with medical relevance can induce nephropathy, leading to Acute Renal Failure (ARF), it is unusual except with bites by Russell‟s Viper, E. Carinatus and members of the genera Crotalus and Bothrops. In India, ARF is mostly associated with Russell‟s Viper and E. Carinatus bites. The incidence of ARF following Russell‟s Viper or E. Carinatus bites is 13-32% in India. A histopathological study was conducted on renal autopsy specimens from those subjects who were admitted to IPGME&R and SNP Hospital, Kolkata as a result of development of acute renal failure following poisonous snake bite. Acute tubular necrosis (100%) and Acute cortical necrosis (25%) were the most significant renal histopathological changes. Glomerular lesions were also present in 30% of cases.

[Snakebite in Iran: diagnosis, treatment and prevention]

Due to different questions about how to handle snakebite and its mortality, snakebite management is an emergency and it is necessary to be discussed about. Snakes are divided to three categories including poisonous, semi-poisonous and non-poisonous. Poisonous snakes are divided to elapidae, viperidae, crotalidae and hydrophidae, each of them cause specific symptoms. Snakebite can cause local and systemic symptoms. Local symptoms include edema, tissue necrosis and bulla. Systemic symptoms include hemotoxicity, neurotoxicity, myotoxicity, nephrotoxicity and cardiotoxicity. In this article snakebite diagnosis, prevention and treatment like antivenom, antibiotic, tourniquet, suctioning, etc. has been discussed

Study of snake bite cases at Liaquat University Hospital Hyderabad/Jamshoro

Envenoming resulting from snakebites is an important public health hazard in many regions. It is common in rural areas not to delay access to life saving anti-venom. The objectives of this study were to know about common types of snakes in local areas, clinical features in snakebite victims, complications in snakebite case, and mortality rate in snakebite victims in rural Sindh. This descriptive study was conducted at 4 medical wards of Liaquat University Hospital Hyderabad/Jamshoro, Sindh from 1st January 2006 to December 2006. One hundred cases with history of snakebite were analysed. Both genders were included in study. Patients with history of trauma, insect bite or thorn prick were excluded from the study. Clotting time [CT] was the main bedside procedure, to assess the degree of envenomation. One hundred [100] cases from both genders, from 8 to 55 years age were reviewed. There were 57 [95%] viper bites [haemotoxic] having haemostatic abnormalities and 3 [5%] elapid [neurotoxic] bites presented with neuroparalytic symptoms. Most cases were from Tando Mohammad Khan and Hyderabad [rural] districts of Sindh. All victims had localized oedema at the site of bite. Fang/teeth marks were noted in [90%] cases. Majority [80%] were bitten on the legs below knee. Some 40% of the cases of snakebite occurred when the patient was asleep. Urban to rural ratio was 1:4.5 and male to female ratio was 4:1. Mean time to arrival at our hospital after the bite was 3 hours and mean duration of hospital stay was 4 days. One patient had acute renal failure [ARF] and disseminated intravascular coagulation [DIC], 3% cases of elapid bites were shifted to ICU for assisted ventilation, 4 patients [5.5%] had adverse effects after anti-venom administration and needed intravenous hydrocortisone, promethazine and subcutaneous adrenaline. The average dose of anti-venom was 60 vials for viper bites and 10 vials for elapibites. Overall mortality rate was 4%. Snakebites are common in the rural population of developing countries. There is need to educate the public about the hazards of snake bite, early hospital referral and treatment

A Case of fabricated snake bite.

Fabricated wounds are the type of injuries, which are produced by a person on his own body or occasionally caused by another person acting in agreement with him. On 9th February 2007, a case-file of post mortem examination was brought to us for the expert opinion with the alleged history of snake bite from a rural hospital about 60 Km from PDU Medical College, Rajkot. On going through the police papers, we found that it was a case of fabricated snake bite in which the accused has raised a fabricated death certificate to gain the money of insurance, while the victim died due to cardiac arrest on account of myocardial infraction as per clinical record of a private hospital where he was declared dead.

Mordeduras de serpientes / Snake bites

En Cuba no existen serpientes venenosas, por tanto los médicos no están familiarizados con el tratamiento de las mordeduras de este animal. No obstante, a pesar de no constituir un problema de salud nacional, se ha considerado la necesidad de abordar este tema, teniendo en cuenta el carácter solidario de nuestra medicina, que ha extendido su ayuda por todo el planeta. Se realizó una minuciosa revisión del tema teniendo en cuenta variables como: distribución geográfica de serpientes venenosas, especies peligrosas, cantidad y modo de identificación, comportamiento del reptil, comportamiento humano frente al reptil, cuadro clínico de la mordedura, complicaciones y tratamiento profiláctico y curativo. Se ofrecen conclusiones relacionadas con la importancia del estudio.

There are no venomous snakes in Cuba, so the physicians are not familiar with the treatment of snake bites. In spite of the fact that this is not a national health problem, it deems necessary to address this topic, taking into account the solidarity character of our medicine that has extended its assistance to the whole planet. A detailed literature review was made on this topic based on variables such as geographical distribution of venomous snakes, dangerous species, number, way of identification, snake behaviour, human behaviour to face the reptile, clinical picture of the bite, complications and prophylactic and curing treatment. Conclusions are provided in relation to the importance of this study.

À Cuba, les serpents venimeux n'existent pas, c'est pourquoi les médecins ne sont pas familiarisés avec le traitement des morsures de ces animaux. Bien qu'il ne soit pas un problème de santé nationale, il est nécessaire d'aborder ce question, tenant compte du caractère solidaire de notre médecine dans le monde entier. Une revue minutieuse de ce sujet a été réalisée tenant compte des variables telles que: distribution géographique des serpents venimeux, spécimens dangereux, nombre et mode d'identification, comportement du reptile, comportement humain devant le reptile, signes cliniques de la morsure, complications et traitement prophylactique et curatif. Des conclusions par rapport à l'importance de l'étude sont présentées.

Mortalidad por contacto traumático con serpiente y lagarto venenosos: México, 1979-2003 / Mortality from contact with poisonous snakes and lizards in Mexico from 1979 to 2003

Objetivo: Describir la tendencia de mortalidad tanto a nivel nacional como estatal causada por la mordedura de víbora y de lagarto venenoso en México, durante los años 1979 a 2003. Material y métodos: Se describe la tendencia de la mortalidad estandarizada por mordedura de víbora y lagarto venenosos registrada en México durante el periodo 1979-2003, en todo el país y en cada uno de los estados de la federación. Las defunciones se obtuvieron de las bases de datos de mortalidad del Instituto Nacional de Estadística, Geografía e Informática (INEGI). Se determinaron frecuencias, porcentajes, tasas crudas, tasas estandarizadas de mortalidad y riesgos relativos de mortalidad con intervalos de confianza a 95%. Resultados: La tendencia de la mortalidad por mordedura de víbora y lagarto venenosos muestra un descenso significativo de 63.5%. La mayor mortalidad por mordedura de víbora y lagarto venenosos se presenta en el sureste del país. Los estados con la mayor mortalidad en el trienio 2001-2003 fueron: Quintana Roo (7.47/1’000,000 de habitantes), Oaxaca (4.01/1’000,000), Veracruz (1.56/1’000,000), Chiapas (1.48/1’000,000), Campeche (1.43/1’000,000) y Yucatán (1.29/1’000,000). Los grupos con mayor riesgo fueron los mayores de 60 años y los del sexo masculino. Conclusiones: Resulta conveniente brindar en México servicios de atención antiviperina médica de emergencia, para evitar la mortalidad causada por contacto traumático con estos reptiles, a pesar de la disminución en los decesos.

OBJECTIVE: To describe the trend of standardized mortality by contact with poisonous snakes and lizards in Mexico from 1979 to 2003. MATERIAL AND METHODS: We describe the standardized mortality trend by contact with poisonous snakes and lizards occurring in Mexico from 1979 to 2003, and report the mortality data bases from the INEGI (Instituto Nacional de Estadística, Geografía e Informática). We determined frequencies, percentages, mortality rates, standardized mortality rates and mortality relative risks with 95% confidence intervals. RESULTS: The general trend shows a statistically significant descent of 63.8%. The highest mortality rate within the 2000-2003 period was reported in Quintana Roo (7.47/1,000,000), Oaxaca (4.01/1,000,000), Veracruz (1.56/1,000,000), Chiapas (1.48/1,000,000), Campeche (1.43/1,000,000) and Yucatan (1.29/1,000,000). The groups with the highest risk are those older than 60 years and males. CONCLUSIONS: In spite of the detected decrease in mortality, the contact with poisonous snakes and lizards still is a public health problem in Mexico. As timely treatment saves lives, it is necessary to include and offer treatment in all emergency units of the country.