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Context: Snake bites pose a considerable public health challenge, especially in rural India. This study intends to assess the clinical characteristics, seasonal patterns, and outcomes of snakebite cases managed at a tertiary care facility in Uttarakhand. METHODS: An observational study was done in a hospital setting over 18 months, encompassing 102 patients admitted due to snake bites. Demographic information, clinical presentations, complications, and treatment results were examined. Results: The majority of patients were aged 16 to 40 years (65.7%), exhibiting a little female predominance (54.9%). The Rural and Plains regions accounted for 81.4% and 80.4% of cases, respectively. Snake Bite rates were highest during the monsoon season, especially in August (19.6%), and the most common biting site was the lower limbs (62.7%). Nonvenomous bites represented 59.8% of cases, but hematotoxic and neurotoxic bites comprised 20.6% and 18.6%, respectively. Hematotoxic bites resulted in coagulopathy (12.7%), whereas neurotoxic bites induced neuroparalysis (10.8%). Prompt intervention, with 65.6% of patients arriving at the hospital within 6 hours, resulted in a recovery rate of 90.2%. The mortality rate was 1.9%, with severe envenomation and treatment delays being the main causes. Conclusion: Snake bites in the Kumaon region primarily impact rural women engaged in agricultural activities. Timely medical intervention is essential for minimizing problems and enhancing outcomes. The results underscore the necessity for increased awareness, prompt treatment protocols, and targeted preventative strategies in rural regions. [ABSTRACT FROM AUTHOR]

Abdullahi Ahmed Ahmed,1 Abdinasir Mohamed Elmi,2 Ismail Gedi Ibrahim,2 Mohamed Farah Yusuf Mohamud3,4 1Department of Emergency Medicine, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia; 2Department of Radiology, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia; 3Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia; 4Tayo Institute for Research and Development, Mogadishu, SomaliCorrespondence: Mohamed Farah Yusuf Mohamud, Mogadishu University, Talex Street, Hodan District, Mogadishu, Somalia, Tel +252615591689, Email m.qadar59@gmail.comIntroduction: Snakebite is a serious and potentially fatal public health concern, especially in tropical and subtropical regions, leading to severe complications. The World Health Organization (WHO) identified snakebite as a Neglected Tropical Disease (NTD) in 2017 and launched a global campaign in 2019 with the goal of halving the number of snakebite-related deaths and disability cases by half by the year 2030.Case Presentation: A 26-year-old farmer male presented with a snake bite and soon developed neurological complications, including diplopia, seizures, and altered mental status with Glasgow coma scale(GCS) of 11 out of 15. Investigations revealed coagulation abnormalities and magnetic resonance venography showed acute thrombosis of the superior sagittal sinus. The patient was diagnosed with superior sagittal sinus thrombosis. He was admitted to the intensive care unit and treated with anticoagulants to manage the thrombus, prevent further clot formation, and administer seizure medications to control any potential seizures associated with the condition. Moreover, we closely monitored the patient’s condition to ensure effective treatment and to address any complications that may arise. Throughout the next three days, the patient’s health gradually improved due to supportive care. He was extubated and transferred to the general ward. He was discharged after 10 days, having made a full recovery.Conclusion: This case report from Somalia emphasizes the importance of recognizing and managing superior sagittal sinus thrombosis as a rare but life threatening consequence of snake bite envenomation, particularly in resource-limited settings where access to advanced diagnostic and treatment modalities may be limited. If a patient experiences headache, impaired vision or seizures, after a snake bite, it is important to be highly suspicious of cerebral vascular complications including venous sinus thrombosis. Moreover, we recommend that a national study be conducted to identify the prevalent snake species in the region and to determine their specific habitats.Keywords: superior sagittal sinus thrombosis, snake bite, magnetic resonance venography

Snake bites pose a significant public health issue in Indonesia, leading to high morbidity and mortality rates. Proper identification of snake species and timely management are crucial. A 70-year-old woman was admitted to the emergency department 1.5 hours after being bitten by a snake. Initial management included applying a tourniquet and symptomatic treatment. However, local envenomation signs, such as edema and bullae, developed within 24 hours. Due to financial constraints, the patient could not receive continuous care, leading to complications, including necrosis and signs of secondary infection during follow-up. This case underscores the importance of early intervention and proper wound management in snake bites, particularly when the species is unidentified. Close monitoring is essential, as symptoms may evolve over time. Educating the patients and public regarding signs of necrosis and proper initial treatment is necessary. Effective management of snake bites requires a comprehensive approach, including prompt medical attention and ongoing education to reduce complications and improve patient outcomes. Keywords: Snake bite, envenomation, wound management, public health

Snake bite envenoming is a public hazard often faced by the rural population in the tropical countries like India. A 59 year old man was brought for post mortem examination with alleged history of non venomous snake bite after which he collapsed within 2 minutes. Autopsy revealed fang marks over the dorsum of left hand middle finger, a few ante mortem injuries and no other significant findings. The cause of death in a venomous snake bite could be due to respiratory failure, shock or hemorrhage with fatal period ranging from a few hours to even days. Many people are terrified of snakes believing that bite by almost any species can cause rapid death. Sudden death after a snake bite may not be attributable to envenoming. We believe that the cause of death in this case was most likely a vaso - vagal attack in response to fear and pain of the snake bite that triggered cardiac arrest. Importance of history and correlation with the autopsy findings helped us in arriving at the cause of death. [ABSTRACT FROM AUTHOR]

Venomous snake bites can result in irreversible damage, leading to respiratory dysfunction, bleeding disorders, kidney damage, or serious complications. In recent years, with the popularity of online shopping in China, snakes can be easily purchased and kept as pets, even if some areas are not natural habitats for certain kinds of snakes. A 13-year-old boy purchased two venomous snakes online as pets. On April 16, 2019,the boy was bitten by a B. multicinctus(Bungarus multicinctus), and he had mild difficulty breathing and limb weakness. He was discharged after symptomatic treatment with B. multicinctus antivenom. On June 17, 2019, the boy was bitten a second time by a short-tailed pit viper (Gloydius brevicaudus) resulting in swelling and necrosis of the left hand. After a systemic and comprehensive treatment was implemented, including Agkistrodon halys antivenom injections, infection control, hormone therapy, improved circulation, negative pressure wound therapy, skin graft, and nutritional support, the boy recovered. This case provides valuable insights for diagnosing and treating venomous snake bites and their complications while also raising public awareness about the hazards of purchasing venomous snakes online,and it also provide case support for the improvement of online shopping for minors, wildlife protection, and live animal mailing management, helping to prevent such incidents from happening again.

A 17-year-old girl was admitted to a private hospital with history of being bitten by snake. She had signs of neurotoxic envenomation in the form of breathing difficulty, chest pain, drooping of both eyelids, and difficulty in swallowing. Report of coagulation parameters was not available. She was treated with anti-snake venom and ventilataory support. She made uneventful recovery after a week and was extubated. There was no history of hypotension/hypertension before or after intubation. Following extubation she developed difficulty in vision which improved over next 2 days. On 9th day after snake bite she was noted to have abnormal movements of all four limbs and tongue tremors so she was transferred to our hospital for further management. On arrival to our hospital she was found to have generalized chorea and tongue tremors. There was no other neurological deficit. Initial MRI brain revealed diffusion restrction in both parieto-occipital regions involving white matter. MRI of spinal cord was normal. Repeat MRI brain after one week showed T2 and FLAIR hyperintesities in both caudate and lentiform nuclei in addition. Cerebrospinal fluid (CSF) examination was normal. On the basis of MRI she was diagnosed as a case of PRES (posterior reversible encephalopathy syndrome) and treated with tetrabenazine. She gradually improved and was discharged. Only few cases of PRES following snake bite have been reported and no case of only movement disorder as manifestation of PRES has been reported.

Abstract Objective To analyze the vulnerability factors of snakebite patients in China. Methods Multi-stage random sampling was used as the main sampling method and snowball sampling as the auxiliary sampling method. The knowledge, attitude and behavior of snakebite among Chinese residents were investigated. Non-parametric test was used to compare the percentage differences in residents’ knowledge, attitude and behavior of snakebite, and generalized linear regression analysis was used to analyze the influencing factors, and the vulnerability factors of snakebite patients were comprehensively analyzed. Results A total of 6338 subjects were included in this study, of which 68.4% were males, and 58.6% were farmers, workers and service personnel. The median total score of knowledge, attitude, and behavior was 26 (22,36). The patients who were improperly treated after injury were ligation proximal to the affected area (23.43%), squeezing (21.82%), and oral and suction wounds (8.74%). Did not go to hospital due to poverty (1351 cases) and did not receive antivenom (2068 cases). There were 21.32% and 32.63%, respectively. Among 4270 patients injected with antivenom 30.7% were vaccinated within 2 h. Among the patients who went to the hospital for treatment (4987), 75.0% arrived at the hospital within 6 h; Among the 4,761 patients who made emergency calls, 37.4% were treated within 0.5 h. Conclusions Snakebite patients in China have weak knowledge about snakebite, low awareness of medical treatment, lack of correct prevention and emergency treatment measures, dependence on folk remedies, poor housing and so on. In addition, there are low availability of antivenoms and unreasonable distribution of medical resources in some areas of China. Multisectoral and multidisciplinary cooperation should be developed to prevent and control snakebites in order to reduce the burden caused by snakebites.

Key Clinical Message: Splenic hematoma secondary to snake bite is a potential complication due to snake envenomation and poses a significant risk to the health of the patients. Although relatively rare, this complication once diagnosed, should be initiated with timely anti‐venom administration and supportive care. Clinicians must be aware of any signs of hematological abnormalities in snakebite patients, as the development of splenic hematoma can have serious implications for patient outcomes. Awareness of this potential complication and multidisciplinary collaboration among medical teams are crucial to ensuring effective management and optimal patient care in these clinical scenarios. Understanding this concern can improve patient prognosis and advance the overall approach to snakebite management in healthcare settings. [ABSTRACT FROM AUTHOR]

Background: Snake bites are one of the most common health problems in tropical and subtropical countries. WHO has included snakebite in the list of neglected tropical diseases. The majority of Indonesians work in agriculture and are at high risk of being bitten by snakes. Pre-hospital handling of snakebites according to WHO recommendations by immobilizing using bandages and splints on the part affected by the snakebite then immediately refer to the nearest health service center.Purpose: This study aims to determine the effect of snakebite health education on people's knowledge and behavior about handling snakebites before going to the hospital in Wungu Village, Wungu District, Madiun Regency.Method: The research design is quasi-experimental with a one-group pre-test and post-test design. The population is the entire community of Wungu Village, Wungu District, Madiun Regency with a sample of 100 respondents by random sampling. Collecting data using a questionnaire analyzed with the Wilcoxon test.Results: The results of the research on community knowledge and behavior before being given health education were 44 people (88%) less knowledgeable and 39 people (78%), after being given health education, more than half of the respondents had good knowledge, namely 26 people (52% ) and many changes from good behavior as many as 29 people (58%).Conclusion: There is an effect of health education on people's knowledge and behavior about handling snake bites before going to the hospital with p = 0.000

Abstract Introduction Snakebite envenomation poses a significant health risk, particularly in low-resource settings where access to proper treatment is limited. Case presentation This study reports two cases of Russell's viper bites in rural Bangladesh, involving 48 and 35-year-old Bangladesh males, respectively, and highlights the difficulties in providing adequate medical care and in treating any complications that may arise. Both cases involved delayed access to healthcare, initial visit to traditional healers, and the development of severe complications such as coagulopathy, renal failure. After the intervention both cases survived which is scarce in low resource settings. Conclusion The cases underscore the importance of early recognition, appropriate management, and improved healthcare infrastructure to optimize survival outcomes in snakebite cases in resource-limited settings. These cases will contribute valuable insights to the field of snakebite management and provide guidance for improving survival rates and outcomes among snakebite victims in Bangladesh.

Background: Acute kidney injury (AKI) is a life-threatening systemic effect of snake envenomation. Monitoring of blood pressure, fluid balance, serum creatinine, blood urea nitrogen and serum electrolytes is useful in managing AKI induced by snake envenomation. Antisnake venom is the effective treatment to prevent or reverse most of the harmful effects of snakebite envenomation. Objectives: • To study the prevalence, the predictors and the outcome of AKI in children with snakebite evenomation Methods: A cross sectional study was conducted on 100 children admitted with snake bite evenomation to PICU at Niloufer hospital from July 2020 to June 2022, satisfying the inclusion criteria were enrolled in the study. A detailed history and systemic examination was done and it was recorded in a predesigned structured proforma. The relevant blood investigations were done. AKI was defined as per KDIGO guidelines based on Serum creatinine values and urine output. Results: The prevalence of AKI was 18%, out of which 38.88% were prerenal and 61.11% were intrinsic renal. Patients belonging to rural areas, with longer time taken for admission, blood urea and serum creatinine levels at the time of admission were found to be the significant predictors of AKI. Higher serum potassium levels and requirement of ionotropes were also significantly higher in patients with AKI. Mortality was present in 3 children who developed AKI (16.66%). These deaths were due to Multiple Organs Dysfunction Syndrome (MODS). Conclusion: Area of residence, time taken for admission, serum potassium, blood urea, serum creatinine levels at admission were the strong predictors of AKI. Early hospitalization, quick ASV administration and adequate supportive care were associated with good outcome. [ABSTRACT FROM AUTHOR]

Objective: Snakebite envenomation‑related thrombotic microangiopathy (TMA) is observed in a subset of patients with venom‑induced consumption coagulopathy (VICC). The study was planned to determine the prevalence of TMA among patients with hemotoxic envenomation admitted to a medical college hospital in Himachal Pradesh, India. Methods: This was a hospital‑based open cohort observational study conducted on patients diagnosed with hemotoxic envenomation. The study period was of 1 year and patients were recruited using a nonprobability sampling method. Hemotoxic envenomation was defined as prolonged bedside 20‑min whole blood clotting time (20 WBCT) following a history of snake bites. TMA was defined as the triad of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury (AKI). Results: A total of 56 patients (32 females and 24 males) were included in the study. The prevalence of TMA was (7/56) 12.5%. Out of the seven patients with TMA, four (57.1%) patients improved without renal replacement therapy and three (42.9%) patients took referrals for getting nephrology services outside the state and hence were lost in follow‑up. AKI was developed in 17 (30%) patients. Conclusion: The study demonstrated that TMA is not an uncommon entity. Investigation protocol for TMA should be included in all patients with VICC. [ABSTRACT FROM AUTHOR]

The protein profile of Bothrops rhombeatus venom was compared to Bothrops asper and Bothrops atrox, and the effectiveness of antivenoms from the National Institute of Health of Colombia (INS) and Antivipmyn-Tri (AVP-T) of Mexico were analyzed. Protein profiles were studied with sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS-PAGE) and reverse-phase high-performance liquid chromatography (RP-HPLC). The neutralizing potency and the level of immunochemical recognition of the antivenoms to the venoms were determined using Western blot, affinity chromatography, and enzyme-linked immunosorbent assay (ELISA). Bands of phospholipase A2 (PLA2), metalloproteinases (svMPs) I, II, and III as well as serine proteinases (SPs) in the venom of B. rhombeatus were recognized by SDS-PAGE. With Western blot, both antivenoms showed immunochemical recognition towards PLA2 and svMP. INS showed 94% binding to B. rhombeatus venom and 92% to B. asper while AVP-T showed 90.4% binding to B. rhombeatus venom and 96.6% to B. asper. Both antivenoms showed binding to PLA2 and svMP, with greater specificity of AVP-T towards B. rhombeatus. Antivenom neutralizing capacity was calculated by species and mL of antivenom, finding the following for INS: B. asper 6.6 mgV/mL, B. atrox 5.5 mgV/mL, and B. rhombeatus 1.3 mgV/mL. Meanwhile, for AVP-T, the following neutralizing capacities were found: B. asper 2.7 mgV/mL, B. atrox 2.1 mgV/mL, and B. rhombeatus 1.4 mgV/mL. These results show that both antivenoms presented similarity between calculated neutralizing capacities in our trial, reported in a product summary for the public for the B. asper species; however, this does not apply to the other species tested in this trial. [ABSTRACT FROM AUTHOR]

Introduction: Snakebite envenomation poses a significant health risk, particularly in low-resource settings where access to proper treatment is limited. Case presentation: This study reports two cases of Russell's viper bites in rural Bangladesh, involving 48 and 35-year-old Bangladesh males, respectively, and highlights the difficulties in providing adequate medical care and in treating any complications that may arise. Both cases involved delayed access to healthcare, initial visit to traditional healers, and the development of severe complications such as coagulopathy, renal failure. After the intervention both cases survived which is scarce in low resource settings. Conclusion: The cases underscore the importance of early recognition, appropriate management, and improved healthcare infrastructure to optimize survival outcomes in snakebite cases in resource-limited settings. These cases will contribute valuable insights to the field of snakebite management and provide guidance for improving survival rates and outcomes among snakebite victims in Bangladesh. [ABSTRACT FROM AUTHOR]

A 17-year-old girl was admitted to a private hospital with history of being bitten by snake. She had signs of neurotoxic envenomation in the form of breathing difficulty, chest pain, drooping of both eyelids, and difficulty in swallowing. Report of coagulation parameters was not available. She was treated with antisnake venom and ventilataory support. She made uneventful recovery after a week and was extubated. There was no history of hypotension/hypertension before or after intubation. Following extubation she developed difficulty in vision which improved over next 2 days. On 9th day after snake bite she was noted to have abnormal movements of all four limbs and tongue tremors so she was transferred to our hospital for further management. On arrival to our hospital she was found to have generalized chorea and tongue tremors. There was no other neurological deficit. Initial MRI brain revealed diffusion restrction in both parieto-occipital regions involving white matter. MRI of spinal cord was normal. Repeat MRI brain after one week showed T2 and FLAIR hyperintesities in both caudate and lentiform nuclei in addition. Cerebrospinal fluid (CSF) examination was normal. On the basis of MRI she was diagnosed as a case of PRES (posterior reversible encephalopathy syndrome) and treated with tetrabenazine. She gradually improved and was discharged. Only few cases of PRES following snake bite have been reported and no case of only movement disorder as manifestation of PRES has been reported. [ABSTRACT FROM AUTHOR]

Venom from a snake is extremely uncommonly consumed by humans. It can be administered in a variety of ways, including a direct bite on the tongue or other parts of the body, or it can be taken as a venom pill at rave parties. The belief is that upon consumption, it provides virility, a sense of elation, and excitement, among other effects. However, it is more often dangerous to the human body and can even be fatal. Only a very small number of cases have been described in publications. In the present case report, a 36-year-old male patient who was an alcoholic and had a history of psychiatric disease initially arrived with anxiety as a result of having consumed snake venom the day before. As for the patient’s vital signs, they were acceptable. For observation, the patient was admitted to the intensive care unit reserved for medicine. However, antisnake venom was not administered. After 24 hours, he was released from the hospital. This is an unusual case where the patient was relatively unharmed after the consumption and didn’t show any obvious lasting effects on the neurological or haematological systems. If the venom is not effectively broken down in the intestines and is absorbed as such, drinking snake venom can have deadly repercussions. The treatment is determined by the features that the patient presents. In the present case, antivenom was not administered, as the need was not justified. However, there may arise situations in other cases where it should be administered sparingly.

Background: Snakebite remains a significant public health problem worldwide, particularly in rural areas with unexpected morbidity and mortality. This study evaluated the clinical, laboratory profile and outcomes in children with snake bites from Eastern India. Methods: This was a retrospective case record-based study between January 2017 and December 2021. The clinical features, complications, laboratory profiles and outcomes were analysed. Results: Thirty children with snake bites were admitted during this study period. There was a male predominance with a ratio of 2.3:1. The mean age of presentation was 10.4 years. About 60% of bites occurred during the rainy season between July and September. Most bites (96%) were on lower limbs, predominantly showing vasculotoxic features followed by neurotoxic and a combined presentation. In this study, around 53% received anti-snake venom (ASV) before reaching our centre; the median time to reach our centre was 13 h. Complications such as acute kidney injury (AKI), cellulitis, shock and coagulation abnormalities were common in those who arrived early (before 6 h) than in those who reached late (after 6 h). Similarly, the mean duration of hospital stay was less for those seeking medical attention early as compared to those reaching late for treatment (4.7 days vs. 7.2 days). Twenty-six out of 30 (86.7%) were discharged without any sequelae, 3 (10%) children were left against medical advice and one died. Conclusions: Snakebite remains a major health problem in children causing significant morbidity and mortality. Children, in general, especially males, are particularly vulnerable because of their playful and explorative nature and considerable time spent in outdoor activities. Preventive measures, education about avoiding traditional first aid methods and early administration of ASV reduce complications, duration of hospital stay and avoid the use of antibiotics.

Key Clinical Message: Snakebite is a significant global public health concern. Venomous snake bites can lead to various life‐threatening clinical conditions that affect different bodily systems. These include the nervous system (neurotoxicity), musculoskeletal system (myotoxicity), cardiovascular system (cardiotoxicity), and blood clotting mechanisms (haemotoxicity). Here, we report a 5‐year‐old boy who was bitten by a snake and presented to the Emergency department with complaints of significant infection, necrosis, and gangrene affecting the three fingers of his right hand. After clinical evaluation and investigations, the patient underwent surgical intervention. The patient was discharged from the hospital after 5 weeks of admission with advice to follow up with a primary care physician and physical rehabilitation therapy to ensure the optimal healing and functionality of the affected hand. [ABSTRACT FROM AUTHOR]

We aimed to determine the epidemiology and clinical management of patients presenting to an Australian tertiary emergency department (ED) with a suspected snake bite. Nepean Hospital covers a geographical area known to harbour venomous elapid snake species. A Retrospective chart review of all patients presenting to Nepean ED from 2011 to 2020 was performed. We searched the electronic medical records (eMR) for triage presentations including search terms of "snakebite", "bite" "envenomation", or "bite-snake" and a discharge or independent diagnosis of "snakebite" or "envenomation". Our review identified 110 patients presenting with snakebite, of whom nine had signs or symptoms indicating envenomation. The most common envenomation syndrome was venom-induced consumption coagulopathy (VICC) and the most commonly suspected culprit snake was the Eastern Brown Snake. Our data broadly agreed with national data on epidemiology and demographics. We noted a satisfactory rate of compliance with local snake bite protocols with evidence of early diagnosis and antivenom administration. We had no cases of anaphylaxis and one case of serum sickness. Our study of a tertiary hospital experience in the management of snake bite demonstrated an appropriate adherence to national guidelines and early clinician recognition of envenomation syndromes. It also demonstrated appropriate antivenom use without obvious time delay. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the thromboelastography (TEG) variables and platelet count after Asian pit viper (Gloydius) envenomation in dogs compared with healthy control dogs. Ten dogs with snake envenomation and twenty healthy dogs were included. There was a significant decrease in G (P=0.017), maximum amplitude (MA) (P=0.012), angle value (P=0.041), platelet count (P<0.001, as well as an increase in K value (P=0.034) and R value (P=0.007) in dogs with snake envenomation. The results of this study revealed that dogs with Asian pit viper (Gloydius) envenomation showed a hypocoagulable state compared with healthy dogs. Our findings may support the use of TEG for diagnosing and monitoring coagulopathy after Asian pit viper (Gloydius) envenomation in dogs. [ABSTRACT FROM AUTHOR]

Background: Snake bite is a major public health problem throughout the world especially in tropical & subtropical countries. The objective of the study is to analyze the factors which determine the prognosis of patients, admitted with poisonous envenomation. These prognostic factors include:- Time since snake bite and admission to Narayana Medical College & Hospital, Nellore, whether patient received first aid or not, systemic involvement and site of bite. Methods: 35patients with history of snake bite with or without fang marks were included in this study and a detailed history of bite including time of bite, type of snake, first aid history, patient's manifestation and history of treatment received from outside was taken. A detailed clinical examination was done and each patient was subjected to investigations like complete blood count, bleeding time (BT), clotting time (CT), prothrombin time (PT), blood urea, serum creatinine, electrolytes and ECG, All investigations were repeated to evaluate the progress. Results: Total patients studied were 35, of which 60% were male, 40 % were female. Highest incidence of snake bite was seen in Age group of 12 -40 years (82.84%), Purely agricultural workers (85.71%), There was more incidence of bite on lower extremity. There were no complications in patients presenting within 6 hours of bite. Out of 35 patients of snake bite 18 were neurotoxic and 17 were vasculotoxic and one patient expired due to respiratory paralysis due to neurotoxic envenomation & one from cerebral bleed due to vasculotoxic bite. Interpretation and Conclusion:- In this study maximum number of patients (54.28%) reported were between 6-24 hours of bite and all those who presented within 6 hours of bite did not have any complications. Systemic involvement worsened the prognosis, the more severe the systemic involvement, the bad is the prognosis. Out of 35 patients one died due to respiratory paralysis resulting from neurotoxic bite and one died due to subarachnoid hemorrhage resulting from viper bite. [ABSTRACT FROM AUTHOR]

Background: Snakebite remains a significant public health problem worldwide, particularly in rural areas with unexpected morbidity and mortality. This study evaluated the clinical, laboratory profile and outcomes in children with snake bites from Eastern India. Methods: This was a retrospective case record-based study between January 2017 and December 2021. The clinical features, complications, laboratory profiles and outcomes were analysed. Results: Thirty children with snake bites were admitted during this study period. There was a male predominance with a ratio of 2.3:1. The mean age of presentation was 10.4 years. About 60% of bites occurred during the rainy season between July and September. Most bites (96%) were on lower limbs, predominantly showing vasculotoxic features followed by neurotoxic and a combined presentation. In this study, around 53% received anti-snake venom (ASV) before reaching our centre; the median time to reach our centre was 13 h. Complications such as acute kidney injury (AKI), cellulitis, shock and coagulation abnormalities were common in those who arrived early (before 6 h) than in those who reached late (after 6 h). Similarly, the mean duration of hospital stay was less for those seeking medical attention early as compared to those reaching late for treatment (4.7 days vs. 7.2 days). Twenty-six out of 30 (86.7%) were discharged without any sequelae, 3 (10%) children were left against medical advice and one died. Conclusions: Snakebite remains a major health problem in children causing significant morbidity and mortality. Children, in general, especially males, are particularly vulnerable because of their playful and explorative nature and considerable time spent in outdoor activities. Preventive measures, education about avoiding traditional first aid methods and early administration of ASV reduce complications, duration of hospital stay and avoid the use of antibiotics. [ABSTRACT FROM AUTHOR]

Viper bite envenomation represents a significant occupational hazard among agricultural workers in India. The viper bite envenomation is usually suspected when a patient presents with predominant local symptoms at the bitten site, including pain, swelling, and necrosis. Further, systemic findings such as diffuse intravascular coagulation, hypotension, and shock may alert physicians of viper bite envenomation rather than a neurotoxic snake bite. However, cerebral complications are rare in viper bites but may potentially fatal. Central nervous system involvement in a viper bite is either due to neurotoxins or hemorrhagins present in the venom, which may induce cerebral thrombosis, ischemia, infarction, and hemorrhage. Here we present a case of a previously healthy adult male who succumbed to extensive subarachnoid, intracerebral, and intraventricular hemorrhages involving bilateral cerebral hemispheres following viper snake bite envenomation. This report highlights the importance of anticipating cerebral complications in viper bite envenomation, a rare occurrence. It also emphasizes the need for early antisnake venom administration to prevent and control systemic envenomation and its complications.

Background: Snakebite is a medical emergency that frequently occurs in different countries. Considering the incidence of annual snakebite in Iran, this study deals with the epidemiology of snakebite in hospitalized patients. Epidemiological data of patients can improve proper and timely treatment of snakebiteMethods: This retrospective descriptive-analytical study was performed using census sampling of snakebite patients. The statistical population included all patients referred to Afzalipour Hospital in Kerman from 2016 to 2018. After collecting data, the results were analyzed using chi-square and paired t-test.Results: A total of 36 snake bites were reported, 28 males and 8 females. The highest frequency was in the age range of 21-40 years. Local complications included pain 55.5, swelling 36.9, erythema 36.1, skin ecchymosis 13.9, tenderness 8.3, and bleeding 1%. Systemic symptoms included nausea and vomiting 16.6, headache 2, drowsiness 2, and 72.4 without symptoms. Out of 36 patients, 8 had compartment syndrome and 4 patients required fasciotomy. Chi-square test showed a significant relationship between bite and sex, bite and season.Conclusion: Local and systemic symptoms of patients indicate that Viperidae snakes are more likely to cause bites in this province. Snakebites have been more commonplace among men and in the age group of socially active people and more in summer. The development of treatment protocol by experienced and eager physicians with Local and systemic manifestation of venom caused by venomous snakes in the region is essential.

Background: India is a country known to the West as a country of snake charmers and snakes. Generation after generation, some families in our country continue to play and live with snakes (snake charmers), but we fail to protect the community from snake bites. Protection from this environmental and occupational hazard requires at least some education of the public with regard to how to protect them from snake bites, as well as what to do after the bite has occurred. Methods: The clinical profile of 88 patients who were admitted to the hospital with snake bites and gave informed consent were studied. Patients were treated with anti-snake venom (ASV) whenever required, the initial dose and total dose of ASV administered were also calculated. Results: Most patients were male (54.5%). The majority of the cases (39.8%) were farmers, followed by housewives (15.9%), daily-wage laborers (13.6%), students (11.4%), and shopkeepers (4.5%). The most common clinical manifestation was an extension of edema beyond the site of bite (29.5%) followed by neurological features (26.1%), pain abdomen (20.5%), vomiting (14.8%), and regional lymphadenitis (12.5%). Out of the 88 cases, 11 cases died and the remaining 77 cases recovered. Mortality was significantly higher among patients with complications such as wound infection (P < 0.0010.000), sepsis (P = 0.000), compartment syndrome (P = 0.028), and haematuria (P = 0.004). Conclusion: Snakebite is an occupational hazard, as more than half of the patients were farmers and labourers. The risk factors such as the time between bite and treatment, snake bite -related complications, and adequate doses of ASV determine the treatment outcome.

Snake bites are an important cause of illness and deaths in the rural population in tropical, subtropical and southeast Asian countries. There are more than 3000 species of snakes found all over the world of which around 300 species are found in India. In India, most of snake bite deaths occur due to delayed arrival to treatment centers. The purpose of the present review article is to explore the various species of snakes, their toxicology, clinical manifestations, and management. In addition, various ways to avoid snake bites and early approaches to government centers rather than private centers for the availability of Anti-snake venom have been discussed in this article. Rapid diagnostic test for the identification of species is available in selective centers only and treatment mainly depends on the administration of anti-snake venom. In addition, proper community education and strong health-care policy will reduce the morbidity and mortality due to snake bites.

One of the most serious complications of snakebite is compartment syndrome (CS), Signs of CS include paresthesia in the distal part and pain that is out of proportion to the severity of the injury, Management involves improving the general condition, and fasciotomy has been found to be effective. An 8-year-old girl was referred to the internal emergency department in our hospital 72 h after a snake bite. She was unconscious, in poor general condition, and had a high fever. Edema was present throughout the right lower limb, extending to the abdomen, with signs of cellular necrosis (blackening with bubbles) on the right foot. The diagnosis of CS was made, and the patient underwent fasciotomy after improving the general condition. Although snake bites are rare, surgeons should be concerned about life-threatening and limb-threatening complications. CS can be effectively treated with fasciotomy. Additionally, it is important to emphasize the significance of daily dressing and regular follow-up for achieving the best results.

Background: Snake bite is an underestimated cause of accidental deaths in India. This hospital based post-mortem study has been carried out at Government Chengalpattu Medical college and Hospital during the year 2021 (1 year). Total of 1437 autopsies were conducted in the mortuary of Chengalpattu medical college and hospital during this period. Out of total 1437 cases of post mortem examinations, 229 poisoning cases noted and out of 229 poisoning cases, Snake bite was observed in 39 (2.71%) cases. Total 27 (69.23%) males and 12 (30.77%) females died due to snake bite. Maximum cases were observed in 11 – 30 years of age group and were 17 (43.59%). The male to female ratio was 2.25:1. Maximum number of deaths belong to rural area, comprising of 31 (79.49%) out of 39, while 8 (20.51%) deaths were belonged to urban area. Maximum deaths are occurred between 6 to 24 hours (46.15%) from bite. The need to educate the public about hazards of snake bite, early hospital referral and treatment. [ABSTRACT FROM AUTHOR]

Case series summary: Three cats in South Korea were diagnosed with snake envenomation based on the appearance and location of bite wounds. Two cats were envenomed by the Gloydius species and one by an unidentified species. Clinical signs were detected, including local bite-site swelling, haemorrhagic discharge and necrosis. All three cats were given supportive treatment. An antivenom was administered to one cat, and the cat showed no adverse reactions. All cats survived, but skin necrosis remained a complication of the snake envenomation. This was observed during the 1-year follow-up period. Relevance and novel information: Cats with snake envenomation are extremely rare in South Korea, and information regarding clinical details are limited. This study is the first to describe the clinical details and prognosis of feline snake envenomation in South Korea. [ABSTRACT FROM AUTHOR]

Venomous snake bites can constitute medical emergencies, and without immediate care may be life-threatening. This study describes the characteristics and management of patients suffering from snake bite injuries (SNIs) in the Jerusalem area. A retrospective analysis of all patients who were admitted to the Hadassah Medical Center emergency departments (EDs) due to SNIs between 1 January 2004 and 31 March 2018 was conducted. During this period, 104 patients were diagnosed with SNIs, of whom 32 (30.7%) were children. Overall, 74 (71.1%) patients were treated with antivenom, 43 (41.3%) were admitted to intensive care units, and 9 (8.6%) required treatment with vasopressors. No mortality was recorded. On ED admission, none of the adult patients presented with an altered mental state compared to 15.6% of the children (p < 0.00001). Cardiovascular symptoms were observed in 18.8% and 5.5% of the children and adults, respectively. Fang marks appeared in all of the children. These findings underscore the severity of SNIs and the differences in clinical presentation between children and adults in the Jerusalem region. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the frequency, common presentation, anti-snake venom (ASV) related management and outcome of snake bite cases in admitted children at a tertiary care hospital. Study Design: Case-series study. Setting: Department of Pediatric, Dera Ghazi Khan Medical College (DGKMC) & Hospital. Period: 1st March 2021 to 31st August 2021. Material & Methods: During the study period, all children presenting with snake bite were included. All cases were observed for their presentation, classified according to signs and symptoms, and managed through ASV as needed. Results: During the study period, a total of 52 patients of snake bite admitted in paediatric medical ward of DGKMC & Hospital. There were 37 (71.2%) male and 15 (28.8%) female. Overall, mean age of the children was 6.1±3.1 years. Maximum number of snake bite cases were reported during May, June and July as 15 (28.8%), 13 (25.0%) and 8 (15.4%) respectively. In the presentation, 29 (55.8%) patients presented with local symptoms only while remaining 23 (44.2%) presented with local as well as systemic symptoms. In the management, 3 (5.8%) cases did not require any ASV vial, 35 (67.3%) needed initial doses only. Fourteen (26.9%) cases required initial as well as maintenance doses. In terms of outcome, 49 (94.2%) children were discharged successfully, 1 (1.9%) expired and 2 (3.8%) got left against medical advice (LAMA). Conclusion: Snake bite was a common pediatric medical emergency at our institute. Most children presented with hemotoxic symptoms and needed ASV for resolution of symptoms. Prognosis is good with timely and judicious management of snake bite. [ABSTRACT FROM AUTHOR]

Snake bites are an important cause of illness and deaths in the rural population in tropical, subtropical and southeast Asian countries. There are more than 3000 species of snakes found all over the world of which around 300 species are found in India. In India, most of snake bite deaths occur due to delayed arrival to treatment centers. The purpose of the present review article is to explore the various species of snakes, their toxicology, clinical manifestations, and management. In addition, various ways to avoid snake bites and early approaches to government centers rather than private centers for the availability of Anti-snake venom have been discussed in this article. Rapid diagnostic test for the identification of species is available in selective centers only and treatment mainly depends on the administration of anti-snake venom. In addition, proper community education and strong health-care policy will reduce the morbidity and mortality due to snake bites. [ABSTRACT FROM AUTHOR]

Case: 56-year-old male who developed post-snakebite compartment syndrome (PSCS) of the upper extremity which was refractory to antivenom administration. He had elevated compartment pressure measurements in his upper extremity. He underwent open fasciotomy for the compartment syndrome, followed by delayed primary closure and skin grafting. He now has two years of follow-up with a functional upper extremity. Conclusion: This is a case of a patient who suffered post-snakebite compartment syndrome from his pet Eastern Diamondback Rattlesnake. This case highlights the importance of correctly diagnosing compartment syndrome and validates fasciotomy as a treatment measure for confirmed post-snakebite compartment syndrome (PSCS).

Background: Snake bite is an established important cause of morbidity and mortality among the poor and rural population across the world including India. India accounts for the highest number of snakebites and related mortality globally. Objective: Identification of factors favoring the mortality due to snake bite. Methodology: A descriptive cross-sectional study was conducted from April 2022 to March 2023, and deaths due to snake bites reported from different health care facilities and community were included in the study. Results: A case-fatality rate of 5.9% due to snake bite was documented in the study. The factors identified as favorable for mortality were delayed treatment, followed by suboptimal care at primary and secondary health care facilities and traditional beliefs of the community. Conclusion: Provision of emergency service as point of care delivery, focusing on provision of training to strength point of care emergency services, co-ordination and linkages with the community members can strengthen the efforts toward reducing the mortality due to snake bites.

ABSTRACT Background: Snakebite is a neglected global health problem with high morbidity. We describe compartment syndrome (CS) cases related to snakebites by Bothrops spp. Methods: The medical records of patients admitted with snakebites envenomation were reviewed. Results: Of 47 patients with Bothrops spp. envenomation (4 male; mean age: 42 years), 7 (15%) developed CS. The mean time to antivenom administration was 9.5 hours. The time to fasciotomy was variable. Seven patients developed infection and four had acute kidney injury. Conclusions: The incidence of CS is higher than that reported previously. This may be due to the clinical severity and long delay before administering antivenom.

This was a cross-sectional study with the aim of characterising Naja nigricincta nigricincta’s oral bacterial flora as well as accompanying sensitivities and resistance towards antibiotics. Naja nigricincta nigricincta (zebra snake) is a spitting cobra indigenous to Namibia. Nasopharyngeal and venom swabs for bacterial culture and antibiotic sensitivity were taken from 37 native zebra snakes originating from the Khomas region that were captured for removal and relocation. Enterococcus faecalis, Proteus spp., Morganella morganii and Pseudomonas spp. were the organisms most often cultured. The antibiotic sensitivity profiles of these organisms suggest ciprofloxacin or a third-generation cephalosporin plus gentamicin or piperacillin-tazobactam as prophylactic antibiotics in case of Naja nigricincta nigricincta bites.

Snakebites occur in the community, not in the Emergency Unit. As such it is important to understand the first-aid concepts and pre-hospital emergency care aspects of this neglected disease. This article will highlight the concepts for emergency care within the context of the current pre-hospital arena and in light of the recent South African Snakebite Symposium consensus meeting held in July 2022, where wilderness rescue, emergency medical services and other medical participants agreed through evidence review and consensus debate on the current best approaches to care of the snakebite victim outside the hospital environment.

Introduction: Cerebral venous sinus thrombosis (CVST) is a rare but highly fatal neurological condition mostly caused by prothrombotic conditions like antiphospholipid syndrome, factor V Leiden, and G20210A prothrombin polymorphism. Snake bites are a rare cause of cerebral venous sinus thrombosis that must be recognized and treated promptly to improve survival. Case presentation: We present a case of a 25-year-old male who developed headaches and seizures following a Viper snake bite. The diagnosis was made based on a magnetic resonance venogram (MRV) showing transverse sinus thrombosis with sigmoid sinus stenosis. Initially, the patient was treated with antivenom and supportive treatment for disseminated intravascular coagulation (DIC). After the diagnosis of CVST, the patient was treated with rivaroxaban and levetiracetam. The patient improved within 1 week of treatment and was advised to follow up in 3 months. Conclusion: A high index of suspicion for cerebral venous sinus thrombosis is required if the patient presents with headaches, seizures, or abnormal vision following a snake bite. Early diagnosis and management can prevent further neurological damage. [ABSTRACT FROM AUTHOR]

Viper bite envenomation represents a significant occupational hazard among agricultural workers in India. The viper bite envenomation is usually suspected when a patient presents with predominant local symptoms at the bitten site, including pain, swelling, and necrosis. Further, systemic findings such as diffuse intravascular coagulation, hypotension, and shock may alert physicians of viper bite envenomation rather than a neurotoxic snake bite. However, cerebral complications are rare in viper bites but may potentially fatal. Central nervous system involvement in a viper bite is either due to neurotoxins or hemorrhagins present in the venom, which may induce cerebral thrombosis, ischemia, infarction, and hemorrhage. Here we present a case of a previously healthy adult male who succumbed to extensive subarachnoid, intracerebral, and intraventricular hemorrhages involving bilateral cerebral hemispheres following viper snake bite envenomation. This report highlights the importance of anticipating cerebral complications in viper bite envenomation, a rare occurrence. It also emphasizes the need for early antisnake venom administration to prevent and control systemic envenomation and its complications. [ABSTRACT FROM AUTHOR]

Background: India is a country known to the West as a country of snake charmers and snakes. Generation after generation, some families in our country continue to play and live with snakes (snake charmers), but we fail to protect the community from snake bites. Protection from this environmental and occupational hazard requires at least some education of the public with regard to how to protect them from snake bites, as well as what to do after the bite has occurred. Methods: The clinical profile of 88 patients who were admitted to the hospital with snake bites and gave informed consent were studied. Patients were treated with anti-snake venom (ASV) whenever required, the initial dose and total dose of ASV administered were also calculated. Results: Most patients were male (54.5%). The majority of the cases (39.8%) were farmers, followed by housewives (15.9%), daily-wage laborers (13.6%), students (11.4%), and shopkeepers (4.5%). The most common clinical manifestation was an extension of edema beyond the site of bite (29.5%) followed by neurological features (26.1%), pain abdomen (20.5%), vomiting (14.8%), and regional lymphadenitis (12.5%). Out of the 88 cases, 11 cases died and the remaining 77 cases recovered. Mortality was significantly higher among patients with complications such as wound infection (P < 0.0010.000), sepsis (P = 0.000), compartment syndrome (P = 0.028), and haematuria (P = 0.004). Conclusion: Snakebite is an occupational hazard, as more than half of the patients were farmers and labourers. The risk factors such as the time between bite and treatment, snake bite -related complications, and adequate doses of ASV determine the treatment outcome. [ABSTRACT FROM AUTHOR]

Abstract Background Snake bite envenoming is a neglected tropical disease with variable clinical presentation, neurotoxic manifestations (respiratory paralysis), rhabdomyolysis, cardiotoxicity, autonomic hyperactivity, and/or coagulation abnormalities. There is limited data on the clinical course of the envenomation in an incidentally diagnosed COVID-19 patient. Case presentation A 17-year-old male with history of snake bite and neuroparalysis developed shortness of breath. He was treated with lyophilized polyvalent anti-snake venom (ASV) on admission in the emergency department and mechanical ventilation. Subsequently, he tested positive for COVID-19 infection. No immunomodulatory therapy was administered, and patient was extubated on the 5th day of ICU admission without any neurological deficit. Conclusions Coinfections of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus with snake bite poisoning lead to diagnostic dilemmas and controversies in management practices. Abnormalities of coagulation need to be cautiously addressed, and cause of development of pneumonia needs to be identified. The rapid recovery of the patient in our case theoretically can be explained on the organ-protective potential of snake-derived peptides; a large case series is however needed to prove the same.

Objective: Snakes are among the predators of any ecosystem and have been seen in different parts of Iran. The report on their distribution in Isfahan province was taken into consideration because of the importance of regional knowledge of these animals. Case report: During this survey, a sample of snakes was collected from north of Isfahan province, Kashan city, the University site of Medical Sciences and the sample was studied. The snake was identified by morphological and habitat characteristics and compared to other photos and data. The specimen belonged to the Colubridae family and non-venomous snakes. This species is distributed in the tropical climatic zone of the province. The species of the tropical region of Kashan city was identified as Platyceps karelini. or spotted snake Conclusion: We identified the habitat of this animal in Kashan city in Isfahan province. By identifying the species of Spotted Desert Racer from the Colubridae family, the number of non-venomous snakes in Kashan reached eight species.

Background: Several biomarkers have been thrown into limelight to be an early predictor of Acute Kidney Injury (AKI). Aim and Objectives:To establish the relation between Urinary IL-18 (UIL-18) and AKI and the reliability for use as early markers in the detection of AKI compared to pre-existing surrogate markers for kidney injury such as creatinine and urea. Material and Methods: This is a cross-sectional study which was conducted at Gandhi Hospital, Hyderabad. Study was conducted for duration between 2018-2020 among the patients presenting with the history of snake bite. Total 80 patients with history of snake bite were included in present study after obtaining the informed consent from them all. The patients were followed up and the data were collected in proforma. Results: Mean age of the patients in present study was 39.32 ± 8.95 years of age, with male preponderance. Majority of the patients came with history of viper bite (45%) followed with unknown snake bite (30%), and (12.5%) each with cobra and krait bite. At 12 hr of admission, IL-18 showed a significant higher mean among AKI patients compared to urea and creatinine which were within the normal range. At 48 hr, all the three variables were significantly higher in AKI patients compared to patients without AKI. The cut-off of the 35.31 pg/ml of the UIL-18 was assessed to predict the AKI at 12 hr of follow-up with sensitivity of 48% and specificity of 93.3%. Conclusion:IL-18 helps to predict the occurrence of the AKI among the patients with snake bite when the urea and serum creatinine levels are well within the normal range at the 12 hr of the admission. There is a strong strength of association between the blood urea and serum creatinine with the UIL-18.

Neurotoxin-related optic neuritis (ON) after snake bite is uncommon. Here, we present a case of a 70-year-old female who developed bilateral painless loss of vision after she received treatment with anti-snake venom (ASV). She had only perception of light on assessment of visual acuity on admission which then improved drastically after administration of intravenous methylprednisolone (MP) after making the provisional diagnosis of ON on the basis of history and clinical findings of the patient. Imaging and visual-evoked potential could not be done initially, and they were done after the administration of intravenous MP which had normal findings. ASV, though being a lifesaving treatment, has been sometimes associated with ON.

Ingestion of snake venom is a rare occurrence. The manner varies from a direct snake bite on the tongue or other body parts or used as a venom pill at rave parties. Very few cases have been described in the literature. An alcoholic male with a history of psychiatric illness presented with anxiety due to ingestion of snake venom the previous day. The patient's vital signs were within the normal range. The patient was admitted in the Medicine intensive care unit for observation. Multivitamins, thiamine, antiemetic were given; however anti snake venom was not administered. He was discharged after 24 hours. Drinking snake venom can have devastating consequences if the venom is not properly broken down in the gut and is absorbed as such. Treatment is based on the patient's presenting characteristics. Monitoring is important to detect any late complications. Categories: Emergency Medicine, Internal medicine. [ABSTRACT FROM AUTHOR]