Role of neostigmine and polyvalent antivenom in Indian common krait (Bungarus caeruleus) bite.

Bungarus caeruleus (Indian common krait) bite during monsoons is common in Northwest India. This study was undertaken to find the effectiveness of neostigmine and polyvalent antivenom in improving neuromuscular paralysis following bite. All the consecutive patients admitted between June 2007 and December 2008 with common krait bite, identified either from brought snake or circumstantial evidence were studied.

A cross-sectional survey of snake oral bacterial flora from Hong Kong, SAR, China.

Objective: To determine the pattern of oral bacterial flora and their sensitivity to antibiotics in freshly captured native snakes in Hong Kong SAR, People's Republic of China.

Methods: Healthy native snakes were captured and kept in a designated centre. Snake species were identified by experienced herpetologists.

A survey of snakebite management knowledge amongst select physicians in Hong Kong and the implications for snakebite training.

Objective: The objective of the study was to assess the level of knowledge regarding snakebite management in doctors likely to treat such bites in the Special Administrative Region of Hong Kong in the People's Republic of China. Key concerns were doctor confidence, consistency of approach, use of anti-snake venom (ASV), and ancillary treatments. Hong Kong hospitals are equipped according to developed country standards, and knowledge therefore becomes the key factor in successful management.

The anti snake venom crisis in Africa: a suggested manufacturers product guide.

Considerable attention has been given to the shortage of anti snake venom in Africa. The current supply is reported to rest at crisis levels, and considerable attention has been given to reporting the crisis. What has been absent is a recommended list of anti snake venoms that suppliers can produce in order to alleviate the problem.

Antisnake venom production crisis--who told us it was uneconomic and unsustainable?

The world of antisnake venom production is currently a gloomy place to visit. It is described as being in crisis, characterized by shortages, producers leaving the market, high prices, and unsustainability. It has been reduced to a pauper-like status, doomed to relying on charitable handouts for resolution.

The global snakebite crisis--a public health issue misunderstood, not neglected.

The global problem of venomous snakebite continues to attract attention despite it being described as a "neglected" issue. The current focus of the World Health Organization (WHO) remains anti-snake venom quality, although "availability and sustainability" of supply are consistently described as the key issues. Sustainability of antivenom supply has been elusive, with cost and pricing in developing countries being cited as the major reasons.

A preliminary survey of Hong Kong snake shops and the potential snake bite risks for the healthcare system.

Consumption of snakes is a traditional part of Chinese life. Snake shops, which provide both the food products and live snakes to the public, are believed by the medical community to stock only local species. The medical risk posed by these live snakes is therefore regarded as manageable as they are indigenous and thus effective anti-snake venom (ASV) is believed to be available.

A locally developed snakebite management protocol significantly reduces overall anti snake venom utilization in West Bengal, India.

Objective: The purpose of this study was to determine the impact of a nationally developed snakebite treatment protocol on the amount of anti snake venom (ASV) used in treating snakebites in a developing country and its effect on mortality. In addition, basic epidemiology data were collected and analyzed.

Methods: Experts in Indian snakebites developed a protocol specifically designed for snakebite treatment in India.

A contextual approach to managing snake bite in Pakistan: snake bite treatment with particular reference to neurotoxieity and the ideal hospital snake bite kit.

Although the snakebite mortality numbers for Pakistan are over estimated, snakebite remains a significant problem of rural areas. Significant improvements are possible with locally developed protocols incorporating the latest research. The use of simple reliable diagnostic tools in managing viperine envenomation and the introduction of monitoring cycles based on physiological criteria can greatly improve outcome.

Time for an alternative perspective: the eternal problem of supply and quality of anti snake venom in the developing world--"it's the economy, stupid".

The "crisis in anti snake venom supply" has been an enduring problem. Despite the frequency with which it appears in the literature, it remains unquantified and an enigma. If there is a serious shortage of anti snake venom (ASV), why has this not been resolved? Anti snake venoms are produced, and yet many suppliers are described as leaving the market.

Snakes of medical significance in India: the first reported case of envenoming by the Levantine viper (Macrovipera lebetina).

This article reports for the first time the medical significance of the Levantine viper (Macrovipera lebetina) in India. This snake is found in India in the mountainous regions of Jammu and Kashmir and is capable of causing necrosis and hemostatic manifestations, as seen in the case reported here. It is thus a class II snake of medical significance, as defined by the World Health Organization grading scale.

The "worldwide shortage" of antisnake venom: is the only right answer "produce more" or is it also "use it smarter?".

A frequent tenet of snakebite literature is what has been described as the "worldwide shortage of antisnake venom" (ASV) and the demand for greater production. Antisnake venom is the mainstay of snakebite management, and thus this principle of "shortage" can impact the view of policy makers when it comes to framing solutions to the problem. This paper presents a model to enable policy makers to assess the amount and utilization of ASV in their areas.

A study of the current knowledge base in treating snake bite amongst doctors in the high-risk countries of India and Pakistan: does snake bite treatment training reflect local requirements?

The call for greater production of better quality anti-snake venom (ASV) is a major thrust in the effort to reduce snake bite mortality. However, snake bite mortality has many causes and these should also be addressed. A key feature of efficient ASV usage is ensuring that doctors are trained to administer ASV only when it is required and in amounts that are necessary to neutralize venom.

The Ebbinghaus retention curve: training does not increase the ability to apply pressure immobilisation in simulated snake bite--implications for snake bite first aid in the developing world.

Pressure immobilisation (PIM) has been recommended for field management of bites by some venomous snakes. A narrow range of pressures under the encompassing wrap is necessary for PIM to limit venom spread. This study sought to evaluate the effect of focused training on volunteers' ability to apply PIM and to retain such skill over time.

Snakebite management in India, the first few hours: a guide for primary care physicians.

Snakebite in India continues to be a matter of medical concern and India remains amongst the group of countries with the highest mortality. India is also one of the world's leading producers of snake venom antiserum and therefore the understanding of the causals of snakebite mortality does not rest in snake venom antiserum shortages. The availability of treatment, particularly close to the scene of the bite, is a crucial factor in ensuring a positive outcome.

Snake antivenom product guidelines in India: "the devil is in the details".

Venomous snakebite continues to exact a tremendous toll in human suffering and mortality in India. Contributing to this problem is the fact that all of the current Indian snake antivenom manufacturers include a great deal of misinformation in the package inserts and guidelines that accompany their products. Examples include erroneous recommendations regarding first aid, misleading information regarding the signs and symptoms to be anticipated after Indian snakebite, and misleading and ambiguous recommendations as to initial dosing and repeat dosing of antivenom.

Snakes of medical importance in India: is the concept of the "Big 4" still relevant and useful?

Snakebites continue to be a major medical concern in India. However, there is very little hard evidence of a numerical nature to enable us to understand which species are responsible for mortality and morbidity. For many decades, the concept of the "Big 4" Snakes of Medical Importance has reflected the view that 4 species are responsible for Indian snakebite mortality--the Indian cobra (Naja naja), the common krait (Bungarus caeruleus), the Russell's viper (Daboia russelii) and the saw-scaled viper (Echis carinatus).