Outcome of poisonous snake bites treated with high dose anti snake venom serum versus low dose –A critical review

Background: In India, about 1 million people are bitten by snakes more in the rural area and they get admitted to hospitals. About 50,000, people die of snake bites every year in India. The patients admitted with poisonous snake bites were treated with polyvalent anti snake venom serum. Aim: To determine the significant difference and outcome between High Dose and Low dose Polyvalent Anti Snake Venom Serum (PVASVS), with regards to age gender and severity of coagulation abnormalities. The cost of ASV has an economic impact and if low dose ASV saves the scarce resource. Materials and Methods: 45 patients bitten by snake admitted and treated which included both males and females were taken up for this study based on Poisson model of sampling. All the patients had cellulitis, renal failure and varying degree of coagulation abnormalities. They were classified into LDG and HDG depending on the number of PVASVS they received which was ≤25 vials or >25 vials respectively. This was decided based on the treatment of ASV analyzed using chi-square contingency statistically for its significance. Results: The age and clotting time as such do not have association to distinguish HDG or LDG. It was revealed that Gender has an effect that female HDG are 26.3% (5 out of 19) as compared to male 73.7% (14 out of 19). In each group, 2 patients died out of 18, LDG (11%) 27 in HDG (7.4%) 62.9% of patients in LDG and 38.8% in HDG required hospital stay more than 10 days. Conclusions: The female gender falls in low dose conserving ASV. The LD ASV demands higher duration of stay (more than 10 days) in the hospital. The age, coagulation abnormality did not establish the significant results in the LDG and HDG.

Acute myeloid leukemia presenting as splenic rupture.

We describe a rare case of acute myeloid leukemia presenting primarily as an acute abdomen due to spontaneous splenic rupture in a 19 years male patient. He was treated with splenectomy after failure of conservative management for splenic preservation but later succumbed to an intracerebral haemorrhage.

Hepatic abscess complicating paratyphoid infection.

Salmonellosis is ubiquitous and is a world-wide public health concern. Liver abscesses are occasionally reported in Salmonella typhi infections, they are a very rare complication of Salmonella paratyphi infections. A 28 year old male patient without any prior medical history presented with fever, abdominal pain and a tender hepatomegaly. The imaging studies revealed multiple liver abscesses and an ultrasound (US) guided aspiration of the abscess yielded heavy growth of Salmonella paratyphi A. He was treated successfully by percutaneous drainage of the abscesses and appropriate antibiotics.

Multiple synovial swellings in BT leprosy. A case report.

A case of Leprosy with multiple synovial swellings has been reported. Rarely these swellings may be an initial presentation and at sites other than dorsum of hand or ankle as was in this case. The literature on the subject is briefly reviewed.