Miller Fisher syndrome (MFS), is an acute peripheral neuropathy, a variant of Guillain-Barre syndrome, that develops following exposure to different viral, bacterial, and fungal pathogens. Patients usually present with a triad of ophthalmoplegia, ataxia, and areflexia. During Covid pandemic MFS has been described associated with novel coronavirus disease 2019 (COVID-19). Here we describe the clinical course, Cerebrospinal fluid (CSF) findings, nerve conduction studies, treatment and outcome of the patient having MFS concurrent with COVID 19.
Background:
India is estimated to have the highest snakebite mortality in the world. In India, around 250,000 incidents of snake bite are reported annually with 50,000 deaths. There are about 236 species of snakes in India, most of which are nonpoisonous. Most snakes found in Kashmir valley are nonvenomous of colubridae family (ptyas mucosus or grass snake).
Materials and Methods:
This Hospital-based retrospective and prospective study was conducted at Sher-i-kashmir Institute Of Medical Sciences Srinagar, a multispeciality teaching hospital having clinics for various medical and surgical specialities. All snake bite patients admitted in department of Emergency Medicine, other specialities, and critical care medicine were taken in this study over a period of 3 years.
Results:
Among a total of 108 cases of snake bite, majority were males (57.40%) and mostly 20 to 50 years of age (68.51%).Majority of victims were from rural areas (93.5%) and most of the bites occurred during day time (87.96%) mainly on the lower limbs (63.88%). Highest number of cases occurred from May to October (98.14%). Most of the victims were farmers. Bleeding was present in 13.88% patients and coagulopathy ( International normalized ratio (INR)>1.2) in 63.88% of patients. Neuroparalytic features were present in 8.33% patients. Mortality in our study was 2.8%.
Conclusion:
Snake bite in our valley is an occupational hazard affecting working class engaged in farming in fields, fruit orchards, and forests in rural areas. There is seasonal variation with most envenomations occurring in peak months of agricultural activities. Non recommended first aid measures like tourniquet and incision are commonly encountered. Regular public health programmes regarding prevention, prehospital management (first aid), and immediate transfer to hospital should be emphasized.
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