Snake bite is a well-known occupational hazard amongst farmers, plantation workers, and other outdoor workers and results in much morbidity and mortality throughout the world. This occupational hazard is no more an issue restricted to a particular part of the world; it has become a global issue. Accurate statistics of the incidence of snakebite and its morbidity and mortality throughout the world does not exist; however, it is certain to be higher than what is reported. This is because even today most of the victims initially approach traditional healers for treatment and many are not even registered in the hospital. Hence, registering such patients is an important goal if we are to have accurate statistics and reduce the morbidity and mortality due to snakebite. World Health Organization/South East Asian Region Organisation (WHO/SEARO) has published guidelines, specific for the South East Asian region, for the clinical management of snakebites. The same guidelines may be applied for managing snakebite patients in other parts of the world also, since no other professional body has come up with any other evidence-based guidelines. In this article we highlight the incidence and clinical features of different types of snakebite and the management guidelines as per the WHO/SEARO recommendation.

Background and Aims:Organophosphorus (OP) compound poisoning is one of the most common poisonings in India. The aim of the study was to study the outcomes and predictors of mortality in patients with acute OP poisoning requiring mechanical ventilation.Methods:A retrospective study was conducted in the intensive care unit and 117 patients were included. Diagnosis was performed from the history taken either from the patient or from the patient's relatives. Demographic data, month of the year, mode of poisoning, common age group, duration of mechanical ventilation, time of starting pralidoxime (PAM), and mortality were recorded. Chi square test, Pearson correlation test, and multivariate binary logistic regression analysis was used. Data are presented as mean ± SD.Results:91.86% (79/86) of cases were suicidal and remaining cases were accidental. Duration of mechanical ventilation varied from less than 48 hours to more than 7 days. Mortality rate was 33.3%, 7.2%, and 100% in those who required mechanical ventilation for more than 7 days, 5 to 7 days, and 2 to 4 days, respectively. Lag time was less than 6 hrs in 13 patients and all of them survived. 17.1% and 28.1% patients died in whom PAM was started 6 to 12 hrs and 13 to 24 hrs after poisoning, respectively. There was statistically significant positive correlation between lag time of starting of PAM with duration of mechanical ventilation and total dose of PAM (P < 0.0001). None of the predictors age, lag time, severity of poisoning, and duration of ventilation were independent predictors of death. Overall mortality rate was 18.6%.Conclusion:Mortality from OP compound poisoning is directly proportionate to the severity of poisoning, delay in starting PAM, and duration of mechanical ventilation. Death is not dependent on a single factor, rather contributory to these factors working simultaneously.

Context:Snake bites are the common cause of morbidity and mortality in tropical countries.Aims:To analyze the outcome of snake bite victimsSettings and Design:Retrospective analysis of data from Intensive care unit, Department of Anesthesiology.Materials and Methods:All the patients admitted in the intensive care unit for snake bite management during the year May 2004 - April 2009 were retrospectively reviewed. The data included age, sex, month and time of incident, site of bite, dose of anti--snake venom, time of anti--snake venom, administration, duration of mechanical ventilation, complications and death of a victim.Statistical analysis used:Pearson's correlation test, paired samples t-test.Results and Conclusions:113 patients reported to the Accident and Emergency with history of snake bite. 26 patients were referred to other hospital, 17 patients were brought dead, and 70 patients were admitted to the intensive care unit. In 59 snake-bite victims, maximum data could be recovered. Krait was the most common type of snake bite reported. There was a male preponderance (69.4%) with age ranging between 20 and 40 years (52.5%). The mean lag time (time elapsed between bite and first dose of anti--snake venom) was 5.3 ± 1.4 h and the mean anti-snake venom dose was 12.3 ± 2.4 vials. There was a positive and significant correlation between lag time and total dose of anti--snake venom (correlation coefficient =0.956, P<0.0001). Overall 72.9% patients required mechanical ventilation with a mean duration of 56.2 ± 16.1 h. 10.2% patients sustained cardiac arrest, 8.7% patients developed ventilator associated pneumonia, 6.7% suffered mild anti-snake venom reaction, 6.7% had hypotension and 5.1% patients developed renal failure. The overall mortality was 5.1%.

Introduction Bedside measurement of optic nerve sheath diameter (ONSD) using ultrasonography (USG) is a useful method for detecting raised intracranial pressure (ICP). The primary and main objective of this study is to estimate ONSD among patients with brain tumor and its regression post tumor resection to assess the correlation as well as diagnostic accuracy of the same. Materials and Methods This prospective observational study was performed in a tertiary health care center over a span of 3 months on 68 adults of either sex, out of which 30 were nonneurosurgical patients, taken as control group. Rest 38 were neurosurgical patients posted for brain tumor resection. Normal ONSD in our population was determined by calculating average ONSD using transorbital USG in individuals of control group. ONSD in neurosurgical patients taken as case group was recorded before surgery, intraoperatively immediately post tumor resection, as well as 12 and 24 hours post surgery. These values were analyzed to see the correlation of ONSD with tumor resection. Results The mean (±standard deviation) binocular ONSD in our population was 4.28 ± 0.28 mm. The mean preoperative binocular ONSD in cases using transorbital USG came out to be 5.43 ± 0.37 mm with 88.23% sensitivity and 100% specificity. Postoperatively, transorbital ONSD showed significant regression at 12 and 24 hours as compared with preoperative values (p-value < 0.05). Conclusion Transorbital ultrasonographic measurement of ONSD could be considered as an indirect indicator of ICP in neurosurgical patients perioperatively. The technique is quick to perform at bedside, feasible in critical patients, and without any harmful effects.