Strikes and stripes of the Saw-scaled Viper in the Western Ghats-A case series.

We describe 5 cases of envenomation and complications related to saw scaled viper (Echis carinatus) bites from the Western Ghats region of Karnataka over a period of 5 years (December 2019-May 2023). Although the smallest member of the Big Four, Saw Scaled viper envenomation is associated with significant morbidity. In our region, envenomation appears to be rare. The careful review of all these cases has suggested VICC with one patient having persistent coagulopathy despite adequate ASV administration, and three patients developing anaphylaxis. It needs to be brought to notice that the complications due to envenoming run high, despite timely administration of ASV. Through these cases, we want to contribute evidence suggesting variable efficacy of Indian polyvalent ASV for Echis carinatus bites and the need for updating protocols for the same.

Falls from Trees in Coastal Karnataka: A Neglected Cause of Polytrauma in Lower-Middle-Income Countries of Similar Agroforestry.

INTRODUCTION: Falls are the second most common cause of injury associated with mortality worldwide and an important type of blunt trauma, which forms a significant percentage of traumatic accidents and emergency department admissions. Falling from a tree is an important problem because of its effect on one's health owing to infirmity caused by injuries, most commonly spinal injuries, and the economic burden that accompanies it. METHODS: A retrospective chart analysis was performed including all the patients with falls from heights who presented to a tertiary care hospital in South India during the summer months of 2018, 2019, and 2020. A structured case record form was used to capture information such as basic demographics, tree species, reason for climbing the tree, and mode of fall, along with the clinical profile, and outcomes from the cases selected from the emergency department registers and cross verified using ICD codes. RESULTS: Despite the existing lockdown due to COVID, an unusual increase in the number of patients getting admitted to the triage with a fall from tree was noted in the year 2020 compared to 2019 and 2018. The most common type of injuries sustained were spinal injuries. Burst fractures were leading types of fractures in the patients with spinal injury. The second most common type of injuries involved were of extremities, with lower extremities more than upper extremities. Two patients had inhospital mortality within 30 days. CONCLUSIONS: Falls from a tree are a neglected and preventable mechanism of trauma with a significant socio-economic impact, as most of the patients are young or middle aged earning members of their families. The burden of this mode of injury is primarily on rural and agricultural communities. Pre-hospital services in areas with vast agroforestry cultivation require dedicated first response clinics. Lockdowns and geographic isolation during disasters or disease outbreaks must also factor in a supply of essential commodities and warrant treatment on an urgent basis to reduce the need and risk of injury from forestry and agricultural activities.

Hump-Nosed Pit Viper Envenomation in Western Coastal India: A Case Series.

The hump-nosed pit viper (HNPV) has historically been considered less medically significant, causing local envenomation, renal injury, and coagulopathy; however, now, it is known to cause life-threatening complications. We describe the clinical presentation, treatment, and complications of 3 confirmed HNPV bites from the state of Karnataka (southwest coastal India). Patient 1, an 88-y-old woman, reported with the live specimen and developed venom-induced consumption coagulopathy (VICC) and thrombotic microangiopathy leading to acute kidney injury requiring blood product transfusions and dialysis. Patient 2, a 60-y-old woman, reported 3 d after envenomation followed by treatment at another hospital where 30 vials of polyvalent anti-snake venom (ASV) were given. She developed VICC and acute kidney injury requiring dialysis. On Day 9 of treatment, she developed a pontine hemorrhage. She died after a transfer to another treatment center closer to her residence. Patient 3, a 25-y-old man, was brought to our emergency department 6 h after being envenomed. He received topical ayurvedic treatment before arrival. He was unconscious and found to have severe VICC with a massive middle cerebral artery infarct. All 3 patients received Indian polyvalent ASV, which does not cover HNPV envenomation, clearly demonstrating the absence of paraspecificity and neutralization in a clinical setting. To our knowledge, Hypnale hypnale envenomation has not previously been reported from Karnataka state. The diagnosis of HNPV envenomation in a country without snake venom detection kits, under-reporting despite serious complications, financial burdens on rural populations afflicted, and poor outcomes due to the lack of a specific antivenom are discussed.

A Tropical Kiss by a Malabar Pit Viper.

Snakebite in India is often attributed to the "big 4," for which polyvalent anti-snake venom is effective. Also significant and less known is the burden of other venomous snakes, one of which is Trimeresurus malabaricus. We report a bite to the face of a tree climber by Trimeresurus malabaricus in the Western Ghats of India, which caused severe local envenomation in the form of facial edema and systemic signs of envenomation, including coagulopathy and hypotension. We discuss the role of thromboelastogram, infrared thermography, and routine diagnostics in this case, which led to the administration of Indian-made polyvalent anti-snake venom. The patient recovered and was discharged without any clinically evident physiological or physical dysfunction.