Haematological changes after snake bite: a clinico-haematological study in a teaching hospital of South Bengal, India

Background: Snake bite is a widely distributed and neglected condition with a significant mortality. Medically significant snakes are: Elapidae, which are mainly neurotoxic and Viperidae, which are hemotoxic. Most studies on snake bites are done in Terai belt of Nepal and this is a first study of its kind in children in western region of Nepal. Methods: This was a 7 year retrospective study in Pediatric unit of Manipal Teaching Hospital, Pokhara, Nepal. Relevant data from all cases of snake bite in children up to 18 years of age was collected in a structured proforma and analyzed. Results: Among the 39 cases of Snake bites; it was more in boys (M: F=1.16:1), from rural areas (62%) and was more common during monsoon (64%). The commonest site of bite was foot (64%). Snakes were identifiable in only 23% of the cases. Local swelling (77%) and pain (74%) were common clinical features. Coagulation profile was deranged in 80% of the patients, hematuria was observed in 13% patients and 15% patients had thrombocytopenia. Most of the snakes were hemotoxic (77%) and only 1 case (2.5%) was neurotoxic. Only 44% of the patients received polyvalent anti-snake venom and blood products were required in 51% of the patients. Most patients improved (75%) and the case fatality rate was 2.5%. Conclusion: Most snakes found in mountainous region of Nepal are hemotoxic and lead to deranged coagulation profile. Mortality is low in hemotoxic as compared to neurotoxic envenomations. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 119-124 DOI: http://dx.doi.org/10.3126/njms.v2i2.8954

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Non-venomous snake bite and snake bite without envenoming in a brazilian teaching hospital: analysis of 91 cases

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46651992000600002 ◽

1992 ◽

Vol 34 (6) ◽

pp. 499-503 ◽

Cited By ~ 23

Author(s):

Paulo Vitor Portella Silveira ◽

Sérgio de Andrade Nishioka

Keyword(s):

Teaching Hospital ◽

Snake Bite ◽

Lower Limbs ◽

Correct Identification ◽

Age Group ◽

Clotting Time ◽

Correct Treatment ◽

Venomous Snake ◽

Local Pain ◽

Venomous Snakes

A retrospective survey of 473 cases of snake bite admitted to a Brazilian teaching hospital from 1984 to 1990 revealed 91 cases of bite without envenoming and/or caused by non-venomous snakes. In 17 of these cases the snake was identified, and one patient was bitten by a snake-like reptile (Amphisbaena mertensii). In 43 cases diagnosis was made on clinical grounds (fang marks in the absence of signs of envenoming). The other 30 cases were of patients who complained of being bitten but who did not show any sign of envenoming or fang mark. Most cases occurred in men (66;73%), in the 10-19 years age group (26;29%), in the lower limbs (51/74;69%), between 6 A. M. and 2 P.M. (49;61%) and in the month of April (16; 18%). One patient bitten by Philodryas olfersii developed severe local pain, swelling and redness at the site of the bite, with normal clotting time. The patient bitten by Drymarcon corais was misdiagnosed as being bitten by a snake of the genus Bothrops, was given the specific antivenom, and developed anaphylaxis. One patient bitten by Sibynomorphus mikanii presented prolonged clotting time, and was also given antivenom as a case of Bothrops bite. Correct identification of venomous snakes by physicians is necessary to provide correct treatment to victims of snake bite, avoiding unnecessary distress to the patient, and overprescription of antivenom, which may eventually cause severe untoward effects.

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Pharmacoepidemiology of Snake Bite Cases at a Tertiary Care Teaching Hospital in Odisha

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2018/28667.11777 ◽

2018 ◽

Author(s):

Kunal Priyadarshi ◽

Jayanti Prava Behera ◽

Abinash Panda

Keyword(s):

Teaching Hospital ◽

Tertiary Care ◽

Snake Bite ◽

Tertiary Care Teaching Hospital ◽

Care Teaching

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A 6 months retrospective observational study to assess the rationality and effectiveness of snake bite management in a tertiary care teaching hospital of rural Bengal, India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20183946 ◽

2018 ◽

Vol 7 (10) ◽

pp. 2047

Author(s):

Satrajit Dan ◽

Ananya Mandal ◽

Abhijit Das ◽

Sourav Chakrabarty ◽

Tanmoy Gangopadhyay

Keyword(s):

Observational Study ◽

Teaching Hospital ◽

West Bengal ◽

Tertiary Care ◽

Snake Bite ◽

Retrospective Observational Study ◽

Standard Protocol ◽

Venomous Snake ◽

Tertiary Care Teaching Hospital ◽

Care Teaching

Background: Snake envenomation is a common life-threatening problem encountered all-over West Bengal particularly in the rural areas. There are a large number of patients attending the Emergency unit and being admitted to the Medicine ward, some in the intensive care unit (ICU) and intensive therapy unit (ITU) of the tertiary health care facilities. The objective of this study was to assess rationality and effectiveness of management of venomous snake bite following standard protocol – Standard treatment guidelines of Government of West Bengal and National snakebite management protocol of Government of India.Methods: This was a retrospective observational study of six months (May - October 2017) duration. Data were collected from the treatment records of patients admitted with history of snake bite in the Medicine ward, ICU and ITU of tertiary care teaching hospital of rural Bengal.Results: Of the 63 venomous bite patients, most (82.5 %) were diagnosed to have features of neurotoxic envenomation. All of them (100%) received anti-snake venom (ASV). There was no incidence of anaphylactic reaction as well as any serious adverse drug reaction following ASV administration. Two patients developed acute renal failure, needed haemodialysis. Overall percentage of mortality was 3.2%.Conclusions: The survival rate in venomous snake bite is found to be high in this institution. The practice of snake bite management is found to be adherent with standard protocol. A multicentric study of longer duration is suggested to draw a firm conclusion.

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Epidemiology and Clinical Outcome of Snakebite in Western Nepal: A Retrospective Study

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v12i1.22618 ◽

2019 ◽

Vol 12 (1) ◽

pp. 53-57

Author(s):

D Karki ◽

B Sharma ◽

R Koirala ◽

A Nagila

Keyword(s):

Retrospective Study ◽

Clinical Outcome ◽

Teaching Hospital ◽

Hospital Admissions ◽

Tertiary Care ◽

Snake Bite ◽

Medical Emergency ◽

Care Hospital ◽

Age Group ◽

Snake Bites

Introduction: Snakebite is an environmental hazard associated with significant morbidity and mortality. It is an important medical emergency and cause of significant numbers of hospital admissions in many parts of the Asian region. In this study, we assess the epidemiology and clinical outcome of snake bite. Methods: This was a retrospective study of all patients with snake bites admitted to the Department of Internal Medicine, Manipal Teaching Hospital, Pokhara, kaski, Nepal. A total numbers of 265 snake bite cases in the period of 2013 to 2016 were enrolled in this study. Snake bite cases by person, place and time along with month of snake bite and time of bite, were analyzed. We also identified the types of snake and site of the bite. Sign and symptoms were clinically observed and the management of the snake bite cases was clinically done. Prothrombin time (PT) test along with INR value was performed by Medical Technologist at the Department of Laboratory, Manipal Teaching Hospital. Data was entered in to the Microsoft excel and analyzed by SPPS version 21.0. Percentages were applied to find the results. Results: Total numbers of snake bite cases were 265. More than half, 60.4% of the snake bite cases were females. Regarding the age group, nearly half, 47.9% were in the age group of 20 - 40 years and 9.8% cases were in the age group of 60 years and above. In this study, 50.6% bite cases were held at the day time and most of the bites were reported/ observed in the limb, 53.6% in lower limb, and 43.4% in the upper limb. Very few bites were in the head, neck and trunk. Our result shows 49.1% were green snake and 30.9% snake were unidentified. When we observed the sign and symptoms, 153 (57.7%) cases showed local swelling, 83 (31.3%) showed fang mark. Hematological manifestation were 144 (54.3%) cases and complication observed in 145 (54.7%) cases. Snake bite cases were managed after PT/INR test, INR. Antibiotic were prescribed in 154 cases and in 135 (50.9%) cases blood was transfused. There were no fetal cases noticed among hospital admitted snake bite cases. Conclusion: There is gross disparity in the management and outcomes of snake bite in different hospitals. Snake bite cases should manage in tertiary care hospital as early as possible.

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Drug usage in the management of snake bite patients in a tertiary care teaching hospital - A retrospective study

International Journal of Medical Science and Public Health ◽

10.5455/ijmsph.2018.0722311082018 ◽

2018 ◽

Vol 7 (11) ◽

pp. 1

Author(s):

Rohini Gupta ◽

Brij Gupta ◽

Apeksha Gupta

Keyword(s):

Retrospective Study ◽

Teaching Hospital ◽

Tertiary Care ◽

Snake Bite ◽

Drug Usage ◽

Tertiary Care Teaching Hospital ◽

Care Teaching

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A comparative study between retrospective and prospective assessment of rationality and effectiveness of snake bite management in a tertiary care teaching hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20192571 ◽

2019 ◽

Vol 8 (7) ◽

pp. 1547 ◽

Cited By ~ 1

Author(s):

Sonai Mandal ◽

Ananya Mandal ◽

Tamoghna Maity ◽

Somenath Das

Keyword(s):

Comparative Study ◽

Teaching Hospital ◽

West Bengal ◽

Treatment Guidelines ◽

Tertiary Care ◽

Snake Bite ◽

Mortality And Morbidity ◽

Tertiary Care Teaching Hospital ◽

Care Teaching ◽

Prospective Assessment

Background: Snake bite envenomation remains one of the commonest causes of mortality and morbidity in rural West Bengal. Objective of present study was to compare the rationality, effectiveness and adherence to standard treatment guidelines of Government of West Bengal of snake bite management over the high-risk periods of two years.Methods: This was a comparative study of snake bite management between 2016 and 2018 (over April to September) during peak risk season in a tertiary care teaching hospital in rural Bengal. The data was collected retrospectively from the treatment records in 2016 and from patients admitted with history of snake bite in the Medicine ward, ICU and ITU in 2018.Results: Records from 2016 yielded 177 snake bite patients (144 venomous and 82.5% neurotoxic envenomation) and in 2018, 190 cases (114 venomous and 71.1% neurotoxic). There was delay in presentation (>2 hours) in almost 80% cases in both years and 2.56% had anaphylactic reaction following ASV administration in 2018 against 3.15% in 2016. Ventilator support was necessary for 12% patients in 2018. Overall percentage of mortality reduced from 6.70% to 3.2% in 2018. Adherence to snake bite management STG was seen in 81.8% of the retrospective records vis a vis 80% cases in prospective analysis (p = 0.21).Conclusions: The survival rate in venomous snake bite is found to be high in this institution over last two seasons of snake bite. The practice of snake bite management is found to be adherent with standard protocol in most cases.

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