Management of Snakebite and Research Management of Snakebite ...

More documents

Recommendations

Info

INTRODUCTION Snakebite is an occupational hazard of our farmers. People in six of 14 states and divisions are engaged in rice farming. Bites occur during the ploughing and harvesting seasons; however, with the introduction of multiple cropping, contacts between snakes and man is increased. Mono-specific antivenom manufactured by Myanmar Pharmaceutical Factory is recommended for treating Russell’s viper bite cases throughout the country. Common clinical features include: systemic bleeding, hypotension and renal failure. Russell’s viper bite has been studied in Tharawaddy, Taungdwingyi, Magwe, Myinmu, Danuphyu, Nyaunglaybin and Kyauksae (Aung-Myint et al., 1998, Kyaw-Than et al., 1997, Min-Than et al., 1998, Myint-Lwin et al., 1985, Myint-Soe et al., 1997, Sann-Mya et al., 1998, Saw- Naing, 1983). Geographical variation of biological properties of Russell’s viper venom (Aye-Aye-Myint et al., 1993, 1994, 1995, Sann-Mya et al., 1994, Tun-Pe et al., 2000) and variable performance of mono specific Russell’s viper antivenom in neutralizing venoms from different localities (Tun-Pe et al., 1999) have been reported. The objective of the study is to determine the possibility of geographical variation of clinical features, antivenom response and outcome of Russell’s viper bite cases admitted to six township hospitals from snakebite endemic divisions. MATERIALS AND METHODS The study was conducted on snakebite cases admitted to six township hospitals, from five snakebite endemic divisions namely, Danuphyu and Yaekyi (Ayerawaddy), Nyaunglaybin (Bago), Myinmu (Sagaing), Kyauksae (Mandalay) and Taungdwingyi (Magwe) Study sites (Figure) in one calender year (between 1995-98). Clinical details of the cases were recorded in standard proforma. Twentyminute whole blood clotting test (Warrell et al., 1977) was used to assess the degree of envenoming. Guidelines for indication of antivenom were explained to medical officers before the trial. Clotting test was done at 2h intervals for 24h in cases presented with clottable blood on admission and for those presented with incoagulable blood, it was repeated at 6h intervals after antivenom till normal clot restoration was restored. Serum was collected on to filter paper strips and venom antigen levels were measured by enzyme immunoassay technique at the Venom Research Laboratory of the Department of Medical Research (Tun-Pe et al., 1991). Clinical Features of Russell’s Viper Bite Cases Admitted to Six Township Hospitals ... Myinmu Kyauksae Nyaunglaybin Danuphyu Yaekyi 35
Management of Snakebite and Research 36 RESULTS A total of 294 Russell’s viper bite cases admitted to six township hospitals were studied. The average age of the victims is 27 yrs (7-75yrs) with male to female ratio of 227:67. Twice as many victims are bitten during daytime compared to night bites. Most are bitten on lower limbs and interval between bite and admission is 3.44hrs (5minutes-46hrs). Average distance travelled is 6.45 miles (0.25-41 miles). Forty-four percent of the cases brought dead snakes for identification. Eighteen percent received pre hospital antivenom. It takes 2.14hrs (20minutes-1230hrs) to get pre hospital antivenom in the villages. Snakes responsible for the bites measured from 10-110cm. Clinical details of the patients are presented in Table 1. Upper Myanmar Lower Myanmar Myinmu Kyauksae Taungdwingyi Danuphyu Yaekyi Nyaunglaybin Number 43 24 134 31 34 28 294 Sex M:F 33:10 20:4 99:35 22:9 32:2 22:6 227:67 (77:23%) Bite day: night Local features and symptoms of the cases are shown in Table 2. Local features like bruising are more common in Yaekyi (23%), Danuphyu (23%) and Taungdwingyi (27%), necrosis in Kyauksae (13%), Taungdwingyi (10%) and Danuphyu (9%), blackening in Danuphyu (45%) and Myinmu (14%). Degree of envenoming of the cases is shown in Table 3. Twenty-eight percent of the cases are not envenomed, 29% local and 43% systemic envenoming. Forty-two percent of the systemic cases developed complications. Mean initial venom antigen level of local Total 29:14 11:13 90:44 24:7 20:14 22:6 196:98 (67:33%) Age 27 (7-71) 24 (13-60) 27 (7-75) 24 (11-68) 30 (14:48) 30 (13-60) 27 (7-75%) Work: walk 37:6 16:8 90:44 20:11 25:9 18:10 206:88 (70:30%) Site lower: upper limb Time Bite/adm: (h) Dist traveled (mile) Snake brought Pre hospital ASV% Pre hospital ASV time (h) Snake’s length (cm) Table 1. Clinical details of 294 Russell’s viper bite cases 26:17 20:4 115:19 25:6 31:3 26:2 243:51 (83:17%) 1.50 (025- 815) 2:40 (020- 2130) 4:05 (005- 4600) 4.45 (230- 1200) 4.55 (020- 1845) 4 (015-630) 3.44 (005- 4600) 8 (0.25) 8 (1.8-23) 8.2 (0.5-41) 4 (0.5-4) 5.5 (1-4) 5 (1-10) 6.45 (0.25- 41) 39/43 - 47/134 7/31 18/34 8/28 119/270 (44%) - - 26/179 (15%) - - 1.44 (025- 650) 2/32 (8%) 16/34 (29%) - 44/245 (18%) 4 (020-1230) 1.0 (030- 700) - 2.14 (0.20- 1230) 29 (23-50) 62 (26-102) 44 (19-103) 26 (23-110) 53 (20-66) 30 (10-50) -
Page 1 and 2: World Health Organization Regional
Page 3 and 4: ii WHO Library Cataloguing in Publi
Page 5 and 6: iv 10. Recent Advances in the Exper
Page 7 and 8: The seminar, convened at the Depart
Page 9 and 10: Early use of antivenom by health wo
Page 11 and 12: � Raising awareness of endotrache
Page 13 and 14: Part 2 Working Papers 7
Page 15 and 16: Management of Snakebite and Researc
Page 41: Management of Snakebite and Researc
Page 93 and 94:
Management of Snakebite and Researc
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
show all

Management of Snakebite and Research Management of Snakebite ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?