A fatal cobra-bite in a snake expert.

A 35-year-old so called snake-expert from Thakurgaon district was admitted in Medicine department of Rangpur Medical College Hospital (RpMCH), Rangpur, Bangladesh on 2nd November 2007 with history of bites by a cobra snake. He was famous for his outstanding works to establish a snake farm first ever in Bangladesh. He had a collection of more than one hundred snakes of different species. He used to hatch eggs of the snakes, feed the young-snakes, collect venoms and sell those. Everyday many visitors used to visit his farm to watch exciting games with poisonous snakes. Several satellite television (TV) channels and some daily newspapers had covered him on different occasions. He was accidentally bitten by a newly caught hungry cobra snake while recording for a satellite TV channel. Following bites he was brought to the hospital three and a half hours later. By that time, neurotoxicity developed. Repeated doses of Anti Snake Venom (ASV) along with respiratory support and other supportive cares were provided. Despite utmost care feasible at RpMCH, patient expired around 49 hours later.

Initial microbiologic studies did not affect outcome in adults hospitalized with community-acquired pneumonia.

Microbiologic studies (MBSs) fail to identify a specific pathogen in more than 50% of patients with community-acquired pneumonia (CAP). The 1993 American Thoracic Society guideline (ATS-GL) for the management of CAP advised selecting initial antibiotic regimens based on severity of illness and comorbidities. Our study evaluated the role of initial MBS in adult patients hospitalized with CAP and treated according to the ATS-GL. In 184 patients hospitalized at our facility for CAP in 1996, and treated according to the ATS-GL, 25 (14%) failed to respond to initial antibiotic regimens. In these nonresponders, there was no difference in mortality between those in whom antibiotics were changed empirically, and those with MBS-guided changes. We conclude that initial MBS may not be warranted in many adult patients admitted for CAP. Exceptions include patients with conditions that predispose to less common, more resistant pathogens.