RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
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|RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, |
|BANGALORE, KARNATAKA |
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|ANNEXURE II |
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|PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION |
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|1. |NAME OF THE CANDIDATE AND ADDRESS |DR.LOKANATH B MADAGANNAVAR |
| | |POST GRADUATE STUDENT |
| | |DEPARTMENT OF GENERAL MEDICINE |
| | |KIMS, HUBLI. |
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|2. |NAME OF THE INSTITUTION |KARNATAKA INSTITUTE OF MEDICAL SCIENCES |
| | |HUBLI. 580022. |
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|3. |COURSE OF THE STUDY AND SUBJECT |M.D. GENERAL MEDICINE |
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|4. |DATE OF ADMISSION TO THE |22- 06- 2013 |
| |COURSE | |
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|5. |TITLE OF THE TOPIC |A STUDY OF CLINICAL PROFILE OF SNAKE BITE IN KIMS HUBLI. |
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|6 |BRIEF RESUME OF INTENDED STUDY. |
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| |6.1 NEED FOR STUDY:- |
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| |Since ancient times, snakes have been worshipped, feared, or loathed. Cobras appear in many tales and myths and are regarded |
| |as sacred by both Hindus and Buddhists. Unfortunately ,snakes remain a painful reality in the daily life of millions of|
| |villagers in this region. |
| |In India ,an estimated 2,00,000 persons per fall prey to snake bite, with an estimated fatality rate of 35000 -50000 per |
| |year. Delayed presentation to hospitals frequently contributes to increased morbidity and mortality from snake bite. |
| |Incidence of complication is directly proportional to the duration of venom in the blood prior to neutralization by antisnake|
| |venom due to late arrival of the patient to the hospital. |
| |In India ,there are 216 species of snakes ,of which only four are venomous snakes(cobra, krait, Russell’s viper and saw |
| |scaled viper). Snake bites are the common cause of morbidity and mortality in tropical countries. Hence ,this study is |
| |undertaken to study the snake bite cases with particular attention to demography, epidemiology, and clinical profile and |
| |preventive measures in our part the country. |
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| |6.2 REVIEW OF LITERATURE: |
| |1. In a study conducted by Dr. Pramiladevi.R dept of medicine, Bagalkot on 139 patients it was found that, the age group |
| |involved was 20-40 years(65%) and majority were males 56% and these bites were during mansoon and during night times and |
| |50.3% had bite marks in lower limbs. 42% had only local signs and needed monitoring and low dose ASV. Most bites in their |
| |area were neurotoxic (30%) with good outcome compared to haemotoxic (9%) .ASV was used in 110 patients and requirement of |
| |ASV was high in haemotoxic (230ml) compared to neurotoxic patients (180ml). 5% developed DIC had fatal outcomes. Ventilator |
| |support and haemodialysis was needed in 7% patients who presented late to hospital & this saved their lives. Mortality was |
| |5%. This study also high lights sociological impact and suggest certain preventive measures to reduce snake bite mortality |
| |and also rationalize ASV usage in different envenomation. |
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| |2. In a study by Dr Ganneru Brunda in osmania university , Hyderbad on 1379 snake bite cases ,peak number of snake bite cases|
| |were seen during June-september. Majority of the cases were observed in age group 21-50yr (71%).Higher incidence of snake |
| |–bite was recorded in males(76%).Of the 22 cases analysed by the ELISA,6 tested positive for cobra venom, while 8 cases |
| |tested positive for krait venom, the remaining specimens tested negative for both cobra and krait venom. This study concludes|
| |that evaluation of forensic specimens (autopsy & biopsy ) of human snake-bite victims based on specific molecular |
| |epidemiological tool like ELISA gives a true estimate of incidence supplementing clinical and circumstantial evidence. |
| |3.In a study at north Indian military hospital by Jasjit Singh, total of 33 cases of alleged snake bites reporting to the |
| |hospital between June and October were included.12 of the 33(33.3%) cases were non venomous and were excluded from subsequent|
| |analysis. The median age was 24 years (range 18-38 years);all patients were men. 81% of bites were in lower third of leg and |
| |feet ;three(14%) were bitten bitten on thigh and buttocks primarily while defecating in open fields. Three patients were |
| |bitten on fingers while cutting grasss. Fang marks were not found in two cases due to swelling. Three patients brought dead |
| |to ED ,which were identified as kraits. A tourniquet was applied in seven cases before presentation to the hospital. All |
| |patients were anxious and agitated. All bites were neurotoxic in nature manifesting as neuroparalytic syndrome. The time of |
| |onset of symptoms was between 30 and 60 minutes, while the time to report to ED ranged between 30 and 180 minutes after|
| |the bite. Abdominal pain(91%), headache(86%), dysphagia (86%), ptosis(77%) ,diplopia(72%) ,blurring of vision (72%), |
| |dyspnea(67%), vomiting (62%),were the predominant clinical presentation. Lassitude (48%), perioral paresthesia (48%), |
| |respiratory paralysis(10%) and dryness of mouth(10%) were the less frequently observed symptoms. Leucocytosis and azotemia |
| |were reported in five patients. Azotemia was pre-renal and this was attributed secondary to recurrent vomiting. Two patients|
| |needed ventilatory support for overt respiratory paralysis. |
| |All 33 cases were hospitalized. Non-venomous bites(n=12) were discharged after 48-72 hours of hospitalization. The median |
| |duration of hospitalization of venomous bite cases was 4 days (range 3-13). The median dose of ASV administered to all |
| |symptomatic patients was 180 ml(range 90-320 ml). One patient developed anaphylaxis and two developed mild pyrexial reaction |
| |to ASV.11(52%) patients received neostigmine with glycopyrrolate to counter cholinergic effects. The median time of recovery |
| |from envenomation was 8 hours(range6-120) after initiating ASV. All patients recovered without any sequelae. |
| |4. In a study at Ahmedabad by Bhavesh jarwani on 156 cases of snake bites, majority (67.4%) of the snake bite victims were in|
| |age group between 15 and 45 years. Majority were male victims (74.2%).71% victims of snake bite lived in rural areas. Farmers|
| |and laborers were the main victims .61.2% incidents took place at night time or early morning(before 6 a.m).64% patients had |
| |bite mark on the lower limb. 40% victims had seen the snake. Eight patients had snake bite ,but were asymptomatic.52% had |
| |neuroparalytic manifestation ,34% were asymptomatic, and 9.6% had hemorrhagic manifestation.14% cases received treatment |
| |within 1 hr of the bite and 64.84% within 1-6 hr after the bite. First aid given was in the form of application of lime, |
| |chillies, herbal medicine ,etc.,(1%).2.20% cases were sensitive to anti-snake venom. Only three patients died. |
| |5. In a study on 586 snake bite cases by Dr suchitra in kottayam medical college,kerala, 200 (34%) of 586 cases with |
| |snakebites had envenoming; 58% were men, 52% were aged 31–50 years and 93% were outdoor bites. The species of snake was |
| |identified in 34.5% of the venomous bites. 93.5% had signs of local envenoming. Regional lymphadenitis occurred in 61%. The |
| |mortality rate was 3%. Capillary leak syndrome, respiratory paralysis and intracerebral bleeding were the risk factors for |
| |mortality. Those who received SAV early (bite to needle time ................
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