Potency assay of the liquid Russell's viper (Daboia russelii siamensis) antivenom stored at different environment

Two methods of storing liquid antivenom (a) keeping it in a sand pot embedded in the ground and another (b) keeping antivenom containing sand pot in a lager sand pot and left in the house with daily and every third day watering of the sand was studied for 7 months covering the winter and hot summer months in Taungoo and Taungdwingyi respectively. Daily watering schedule kept the sand] -2C cooler than the every third day watering and maintained the temperature of the sand at 30-32C with a difference of 8-1 OC lower than the environmental temperature of 40C during the hot summer months. The efficacy of the antivenom stored in the first method with daily watering was found to be comparable to the control and superior to the antivenom stored in the first method with every third day watering and the anti venom stored in the second method with daily watering. It is recommended that liquid antivenom should be stored in a sand pot embedded in the ground with daily watering of the sand in places where no cold storage facility is available. This method of storage is simple, effective and inexpensive and could be carried out by the rural farmers.

Acceptability study of protective boots among farmers of Taungdwingyi Township

Acceptability of fang-proof protective boots was studied in 180 farmers of Taungdwingyi Township during harvesting season, October 1995. The boots were provided free of charge. Preliminary survey showed that 98 per cent of farmers knew snake-bite could be prevented by working with boots on and only 72 per cent wore them whereas 28 per cent non-users could not afford to buy them. At present 88 per cent wear locally available rubber boots, which could not withstand penetration of Russell's viper's fangs. Following the trial, 99 per cent enjoyed wearing the trial boots. These provide full sense of protection against snakebite. These are light, comfortable and the farmers could work with them on for the whole day either intermittently or continuously. Ninety-nine percent preferred to wear the trial boots in future and intended to use them even if these are not provided free of charge. The boots cost 350 kyats per pair. Ninety-nine percent could afford to buy them at a price of 250 kyats per pair, however 1

preferred a lower price of 150 or 200 kyats per pair. 1n order to bring down the incidence of snakebite throughout the country, all-out wearing of the boots is needed and it is suggested that health education, selling and distribution of the boots directly to the users at an affordable (subsidised) price of 250 kyats or less per pair should be aimed at.

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.

Study of venom neutralising efficacy of monospecific cloudy liquid antivenom

Venom neutralizing efficacy of a batch of monospecific cloudy liquid antivenom H 93723 expiry 8-9-97 was assessed retrospectively on seven systemic Russell's viper bite cases. Each received 40 mls (4 ampoules) of antivenom which includes one to four ampoules of cloudy antivenom. Venom antigen and antivenom levels before and after the antivenom were followed up to 72 h by enzyme immunoassay technique. Results indicated that in severe envenomed cases (venom level > 80 ng/ml) (n=4), venom antigen remained detectable up to 8 to 12 h and antivenom was not detected until 4 to 10 h (12-20 h in 2 cases) after the antivenom. Dose related neutralising efficacy of cloudy antivenom was observed. Five out of 7 patients were fatal. Use of cloudy or precipitated antivenom should be discontinued.

Comparison between efficacy of oral artemether 480mg and combination of oral artemether 480mg and mefloquine 1000mg in acute uncomplicated p. falciparum malaria

A prospective study comparing the efficacy of Artemether capsule (160 mg. tat and 80 mg. 12 hourly for four doses with a total dose of 480 mg.) as a single drug regimen and a combination drug regimen of Artemether capsule 480 mg. as above together with oral Mefloquine two equal split doses (500 mg 6 hours apart) was carried out at the No. 2, Military Hospital, Yangon during January 1993 and September, 1993. 30 patients were included in oral Artemether single drug regimen and 35 patients were included in oral Artemether and Mefloquine combination drug regimen. The mean age of two groups were 25.82 years and 25.37 years respectively. The initial parasite counts were 13736 and 16879 per microlitre respectively. All patients cleared the parasites initially in both groups. However, 12 patients (40 percent) recrudesced as RI cases in Artemether single drug regimen and thus cure rate was 60 percent. In combination drug regimen group 2 patients (5. 71 percent) recrudesced and cure rate was 94.29 percent. The parasite clearance time (PCT), fever clearance time (FCT) and 50 percent reduction time were compared in both groups and the results were 44.85*** 19.01 hours, 26.56*** 14.14 hours, 40.25*** 16.76 hours, 23.77*** 18.69 hours and 14.28*** 10.11 hours, 12.94*** 6.86 hours respectively. Significant side effects were not noted among patients in both groups. This study showed that Artemether capsule and Mefloquine combination drug regimen has higher efficacy interms of PCT, FCT and 50 percent reduction time than Artemether capsule single drug regimen for patients with acute uncomplicated falciparum malaria in Myanmar.