Title: Evaluation of Outcome Determinants in Snakebite Victims in A Rural Medical College of South Bengal
Authors: Gantait Kripasindhu, Gantait Ishita, Som Kunal
DOI: https://dx.doi.org/10.18535/jmscr/v4i12.60
Background: Snake bite is a neglected public health problem in India. Hence, identification of the clinical parameters as reliable determinants of mortality which may be used at peripheral levels of health care, is essential. Methods: Hospital records of 232 patients (165 males and 67 females) with age ranging from 12 to 80 years, admitted to Midnapore Medical College in south Bengal during January 2015 to December 2015 were reviewed retrospectively. Results: 98% snakebites were on extremities; more in legs (67%) than hands (31%). Most (53.5%) bites occurred in the morning (4 am to noon). Mean (SD) time for bite-to-hospital and bite-to-injection of anti-snake venom (ASV) was 144.6 (77.6) and 169 (182.8) minutes respectively. Twenty seven cases (11.9%)had died. Case fatality ratio (CFR)was significantly higher in89 patients with un-clotted blood as compared to 143 patients with clotted blood (25.9% vs 1.8%, p<0.0005). Significantly higher CFR was observed in 112 patients who received ASV in >2 hours after the bite compared to 120 cases who received ASV within two hours (8.9% vs 0.9%, p <0.0001). Odds ratio of fatality were higher among those who had urine output of<400ml in the first 24hours (OR 26.4). Conclusions: Clinical indicators could be used by healthcare providers for referral to identify snake bite patients who may have fatal outcome. Keywords: Snakebite, urine output, anti-snake venom, outcome, determinants, Bengal. 1. Gold BS, Dart RC, Barish RA. Bites of venomous snakes. N Engl J Med. 2002;347:347–56. 2. Bawaskar HS. Snake venoms and antivenoms: Critical supply issues. J Assoc Physicians India. 2004;52:14–7. 3. Meenatchisundaram S, Parameswari G, Michael A, Ramalingam S. Neutralization of the pharmacological effects of Cobra and Krait venoms by chicken egg yolk antibodies. Toxicon. 2008;52:221–7. 4. Waghmare A, Deopurkar RL, Salvi N, Khadilkar M, Kalolikar M, Gade SK. Comparison of Montanideadjuvants, IMS 3012 (Nanoparticle), ISA 206 and ISA 35 (Emulsion based) alongwith incomplete Freund's adjuvant for hyperimmunization of equines used for production of polyvalent snake antivenom. Vaccine. 2009;27:1067–72. 5. Simpson ID, Norris RL.Snakes of medical importance in india: Is the concept of the “Big 4” still relevant and usefull? Wilder-ness and Environmental Medicine. Wilder-ness Medical Society. 2007:18 (1):2-9 6. Joseph JK , Simpson ID et all. “First authenticated cases of life threatening envenoming by the hump-nosed pit viper (hypnalehypnale) in India. Transactions of the Royal Society of Tropical Medicine and Hygiene.2007:101(1): 85-90. 7. Alirol E, Sharma SK, Bawaskar HS, Kuch U, Chappuis F. Snake bite in South Asia: A review. PLoSNegl Trop Dis. 2010; 4:e60. 8. Warrell DA. Snake bite. Lancet. 2010; 375:77–88. 9. Narvencar K. Correlation between timing of ASV administration and complications in snake bites. J Assoc Physicians India. 2006;54:717–9. 10. Paul V, Pratibha S, Prahlad KA, Earali J, Francis S, Lewis F. High-dose anti-snake venom versus low-dose anti-snake venom in the treatment of poisonous snake bites-a critical study. J Assoc Physicians India. 2004;52:14–7. 11. Tun-Pe, Ba-Aye, Aye-Aye-Myint, Tin-Nu-Swe, Warell DA. Bites by Russell’s vipers (Daboiarussellisiamensis) in Myanmar: effect of the snake’s length and recent feeding on venom antigenaemia and severity of envenoming. Trans R Soc trop Med Hyg. 1991; 85(6): 804 12. Maung-Maung-Aye. Snake-bite-clinical features and treatment: 23rd Burma Med-ical Conference Abstract. Burma, 1976. 13. Than-Than, Hutton RA, Myint-Lwin, Khin-Ei-Han, Soe-Soe, Tin-Nu-Swe, Phillips RE, Warrell DA. Haemostatic disturbances in patients bitten by Russell’s viper (Viperarussellisiamensis) in Burma. Br J Haematol. 1988; 69(4): 513-20. 14. Bandyopadhyay SK, Ghosh S, Bandyopadhyay R, Dutta A. Prognostic factors in haemotoxic viper bite: analysis of data from a referral hospital. J Indian Med Assoc. 2009; 107(1): 12-3 15. KoKoNaing. A study of peritoneal dialysis in acute renal failure patients due to russell’s viper bite. M.Med.Sc (Internal Medicine) Dissertation. Mandalay: University of Medicine, 2004. 16. Sharma SK, Chappuis F, Jha N, Bovier PA, Loutan L, Koirala S. Impact of snake bites and determinants of fatal outcomes in southeastern Nepal. Am J Trop Med Hyg. 2004; 71: 234-238. 17. Warrell DA. Snake venoms in science and clinical medicine. 1. Russell’s viper: biology, venom and treatment of bites. Trans R Soc Trop Med Hyg. 1989; 83(6): 732-40. Dr Kripasindhu Gantait BE – 38/B Bidhan Nagar East, Midnapore town – 721101, West Bengal INDIA Email: This email address is being protected from spambots. You need JavaScript enabled to view it., 09434243054Abstract
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