Management of Snakebite and Research Management of Snakebite ...

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• Reduced morbidity reduces the health care burden and economic loss. RECOMMENDATIONS References Snakebite Control in Myanmar • The quality and management of antivenom supply should be enhanced for improved outcome of the victims of snakebite. • More dialysis centres should be instituted to help in the reduction of mortality from snake bites and other acute renal failure cases such as gastroenteritis, leptospirosis, septic abortion, malaria, accidents and trauma. These critically ill patients, too ill to travel, can be dialyzed without delay. • Intensive care centres should be set up in endemic townships. • Immunodiagnostic kits should be made available to the medical personnel to improve the diagnostic and assessment skills and lead to a fall in mortality from snakebite. 1 Thein-Hlaing, Epidemioligy of snake Bite in Burma Dissertation submitted for Diploma of Preventive & Tropial Medicine, Institute of Medicine I. 1970. 2 May-May-Win, Aung-Thaike-Tun, Win-Win-Haling, Ye-Yint, Le-Le-Soe, Khine-Khine-Shein, Antivenom therapy in cobra bite patients in Sanpya Hospital. Paper presented, Myanmar Health Science Congress 2001. 3 May-May-Win, Win–Naing-Tun, Sandar-Min. KAP of the people in Ayeyarwaddy division. Myanmar Medical Conference 1996. 4 Tin-Myint, Rai-Mra, Maung-Chit, Tun-Pe. Warrell DA. (1991). Bites by the king cobra (Ophiophagus hanna) in Myanmar: Successful treatment of severe neurotoxic envenoming . Quart J Med, 80: 751-62. 5 Aye-Aye-Myint, Tun-Pe and Tin-Zar-Maw (2001). A colloidal dye dipstick for rapid diagnosis of Russell’s viper (Daboia russelii siamensis) bite. Myanmar Health Research Science Congress abstract p 41. 105
Management of Snakebite and Research 106 A Dipstick Test for Rapid Diagnosis of Russell’s Viper (Daboia russelii siamensis) Bite (A 20 minute Russell’s viper dipstick) OBJECTIVES Aye-Aye-Myint, Tun-Pe and Tin-Zar-Maw Venom Research Laboratory,Department of Medical Research (Lower Myanmar) • To develop a robust rapid test for diagnosis of Russell’s viper bite • To select and estimate antivenom doses required for treating the case RATIONALE • Russell’s viper bite is an occupational hazard of our farmers. • Only 44% of the victims brought dead snakes for identification. • 28% of the victims are not envenomed. • 50% of non envenomed cases are given 1-4 ampoules of antivenom. • At present- selection of antivenom for treating snakebite cases is based on: • If snake is brought -species identification • If no snake is brought -syndromic approach plus circumstances of the bite • A rapid diagnostic test is required for:- - Identification of inflicting snake - Selection of an appropriate antivenom - Estimation of antivenom dose - Minimize wastage of expensive antivenom • A rapid enzyme immunoassay dipstick test developed - needs to use expensive reagents - takes 40 minutes to get the result. • A less expensive and more rapid diagnostic test is urgently needed.
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