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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