Hump nosed pit viper envenomation is not rare in Kerala and can cause death, unlike the earlier belief. Available anti snake venoms does not cover pit viper. So, antivenom for this snake is urgently required.
Background
Local envenomation following snakebites is accompanied by thermal changes, which could be visualized using infrared imaging. We explored whether infrared thermal imaging could be used to differentiate venomous snakebites from non-venomous and dry bites.
Methods
We prospectively enrolled adult patients with a history of snakebite in the past 24 hours presenting to the emergency of a teaching hospital in southern India. A standardized clinical evaluation for symptoms and signs of envenomation including 20-minute whole-blood clotting test and prothrombin time was performed to assess envenomation status. Infrared thermal imaging was done at enrolment, 6 hours, and 24 hours later using a smartphone-based device under ambient conditions. Processed infrared thermal images were independently interpreted twice by a reference rater and once by three novice raters.
Findings
We studied 89 patients; 60 (67%) of them were male. Median (IQR) time from bite to enrolment was 11 (6.5–15) hours; 21 (24%) patients were enrolled within 6 hours of snakebite. In all, 48 patients had local envenomation with/without systemic envenomation, and 35 patients were classified as non-venomous/dry bites. Envenomation status was unclear in six patients. At enrolment, area of increased temperature around the bite site (Hot spot) was evident on infrared thermal imaging in 45 of the 48 patients with envenomation, while hot spot was evident in only 6 of the 35 patients without envenomation. Presence of hot spot on baseline infrared thermal images had a sensitivity of 93.7% (95% CI 82.8% to 98.7%) and a specificity of 82.9% (66.3% to 93.4%) to differentiate envenomed patients from those without envenomation. Interrater agreement for identifying hot spots was more than substantial (Kappa statistic >0.85), and intrarater agreement was almost perfect (Kappa = 0.93). Paradoxical thermal changes were observed in 14 patients.
Conclusions
Point-of-care infrared thermal imaging could be useful in the early identification of non-venomous and dry snakebites.
BACKGROUND:To evaluate the prescription of aspirin for primary and secondary prevention of cardiovascular disorders in diabetic patients, in the light of American Diabetes Association guidelines.MATERIALS AND METHODS:In this retrospective analysis, presence of any cardiovascular disease or cardiovascular disease risk factor as defined in American Diabetes Association guidelines and the use of aspirin and other medication data were extracted from the case files of 100 patients with type 2 diabetes mellitus visiting two teaching hospitals.RESULTS:Of 100 patients studied, 58% were men and 42% women and all were ≥ 40 years of age. 45% had at least one cardiovascular disease and all (100%) were on aspirin for secondary prevention; 45% had one or more risk factors, of which 11% (05/45) had aspirin prescribed for primary prevention; remaining 10% had neither risk factors nor cardiovascular disease (but age ≥ 40 years) and no aspirin documentation. Reasons for not using aspirin/antiplatelet drug were not recorded.CONCLUSIONS:American Diabetes Association recommendations for aspirin use for secondary prevention of cardiovascular diseases were strictly adhered to, in contrast to that for primary prevention. Under-prescription of aspirin could be attributed to the physicians' concern about the burden of poly-pharmacy and toxic effects of aspirin on long-term use. Extensive efforts are necessary to enhance aspirin use in this regard.
Aim: Dietary fats may affect coronary artery disease risk by influencing factors other than serum cholesterol. The effect of diets containing coconut oil and sunflower oil without cholesterol supplementation on oxidative stress and lipid peroxidation was studied in male New Zealand White rabbits. Methods: Animals assigned to four groups (control, cholesterol-fed, coconut oil-fed and sunflower oil-fed), given an isocaloric diet and studied for 6 months. The lipid profile, reduced glutathione, glutathione peroxidase, superoxide dismutase, vitamin C and lipid peroxidation were evaluated at the beginning of the study, at the third month and at the end of the study period. Results: Serum lipid values did not show significant variation between animals fed coconut oil and sunflower oil, but total cholesterol, triglycerides and LDL-cholesterol were significantly higher and HDL-cholesterol was reduced in cholesterol-fed animals. Lipid peroxidation was higher in cholesterol-fed and sunflower oil-fed rabbits compared to controls and coconut oil-fed rabbits. Though other parameters such as reduced glutathione, glutathione peroxidase, superoxide dismutase and ascorbate did not vary between the two oil-fed rabbit groups, cholesterol-fed rabbits showed severe oxidative stress. Conclusion: We conclude that in the absence of cholesterol supplementation, coconut oil intake up to 30% of daily energy supply did not cause hypercholesterolemia or oxidative stress in rabbits.J Atheroscler Thromb, 2010; 17:213-218.
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