A prospective study on clinico-epidemiological profile and outcome in management of poisonous snake bite

Abstract

Background: Snake bite is a major health problem in Nepal. According to WHO, annual morbidity due to snake bite is 162 out of 100,000 people in Nepal. Aim of the study is to observe epidemiology, clinical features, and analysis of possible relationship between time delay in administration of anti-snake venom (ASV) and mortality. Methods: This prospective observational study analyses the data of 81 patients admitted to the Lumbini zonal hospital, Butwal, Rupandehi, Nepal with history of snake bite between April to September, 2017.Results: In this study 56% patients were female. Patients of age group (15-30) years were maximum (38.27%). The study showed that 50.61% of snake bites were occurred outside home. Most of patients (84%) were from the Terai region. Average no. of vials used per case was (28±10) vials. Most of victims of snake bite were from rural areas. In most of cases we found that prothrombin time was prolonged. It was found that most of patients 57% reach hospital before 4 hours of snake bite. The mean days of hospital stay was 6±2.86. Most of case of snake bite was unknown (62%). The mortality rate in this study was 6.17%.Conclusions: There is a great need to improve in existing health care conditions for effective management of snake bite; it requires training of the personnel engaged in the emergency health care management, development of national guidelines based on the clinical trials, improving the distribution and easy availability of antivenom.

Study of clinical profile and outcome of patients with snake envenomation at Bheri Hospital Nepal

“…Ptosis was the most common presenting feature in most of the studies. 2,8,17,19 Ptosis was followed by shortness of breath in these studies 8,19 however in this study ptosis was swallowing difficulty. GI symptoms nausea, vomiting, pain abdomen and parotid tenderness were predominant symptoms after ptosis in recently published study from farwest Nepal.…”

“…More than two third bite are within the house and mostly during sleep.6 This finding is contrast to other studies where most of the bite had taken place outdoors in fields or garden. 8,11,16 Around one fourth of the patients had tourniquet as first aid for snake bite. There were few cases of sucking wound, incision and consultation with traditional healers which was similar with the finding of other studies.…”

“…11,16 The lapse for reaching hospital <4hours was around 40% which is similar to other studies. 8,16 This due to the fact initially people go to traditional healers, take ayurvedic medicines and moreover delay in getting transport easily. A study from eastern Nepal has reported usefulness of motorcycle for transport of snake bite victims.…”

“…15 Dysphagia, dysphonia, salivations, neck muscle weakness, blurring of vision were other common presentations. 2,6,8,17,19 Most of the patients were successfully managed at wards, 6(10.34%) patients were admitted in intensive care unit and 4(6.89%) required ventilator assistance due to respiratory paralysis. These patients usually presented late due to delay while transferring and attending alternative measures for snake bite management including traditional healers or ayurvedic medications.…”

“…Cobra venom blocks the postsynaptic receptors and needs more ASV and neostigmine. 8 This study aims to find the socio demographic characteristics, common sign and symptoms of envenomation and the factors affecting the outcome of snake bite envenomation. No.…”