BackgroundSnakebite-related acute kidney injury (AKI) is a common community-acquired AKI in tropical countries leading to death and disability. The aims of this study were to (1) determine the occurrence of snakebite-related AKI, (2) assess factors at presentation that are associated with snakebite-related AKI, and (3) determine the outcomes of patients with snakebite-related AKI.MethodsWe conducted a prospective observational study of patients with snake envenomation at the three academic tertiary care hospitals in Yangon, Myanmar between March 2015 and June 2016. Patient data including baseline characteristics, clinical and laboratory findings, hospital management, and outcomes were recorded in a case report form. A stepwise multivariate logistic regression analysis using a backward selection method determined independent factors significantly associated with AKI.ResultsAKI was observed in 140 patients (54.3%), the majority of whom were AKI stage III (110 patients, 78.6%). AKI occurred at presentation and developed during hospitalization in 88 (62.9%) and 52 patients (37.1%), respectively. Twenty-seven patients died (19.3%), and 69 patients (49.3%) required dialysis. On multivariate logistic regression analysis, (1) snakebites from the Viperidae family (odds ratio [OR]: 9.65, 95% confidence interval [CI]: 2.42–38.44; p = 0.001), (2) WBC >10 × 103 cells/μL (OR: 3.55, 95% CI: 1.35–9.34; p = 0.010), (3) overt disseminated intravascular coagulation (OR: 2.23, 95% CI: 1.02–4.89; p = 0.045), (4) serum creatine kinase >500 IU/L (OR: 4.06, 95% CI: 1.71–9.63; p = 0.001), (5) serum sodium <135 mmol/L (OR: 4.37, 95% CI: 2.04–9.38; p < 0.001), (6) presence of microscopic hematuria (OR: 3.60, 95% CI: 1.45–8.91; p = 0.006), and (7) duration from snakebite to receiving antivenom ≥2 h (OR: 3.73, 95% CI: 1.48–9.37; p = 0.005) were independently associated with AKI. Patients bitten by Viperidae with normal renal function who had serum sodium <135 mmol/L had a significantly higher urine sodium-to-creatinine ratio than those with serum sodium ≥135 mmol/L (p < 0.001).ConclusionsIdentifying factors associated with snakebite-related AKI might help clinicians to be aware of snakebite patients who are at risk of AKI, particularly patients who demonstrate renal tubular dysfunction after Viperidae bites.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0510-0) contains supplementary material, which is available to authorized users.

Patients who present with these independent predictive factors should be recognized and provided with early appropriate intervention to reduce the mortality rate among adults with snake envenomation in Myanmar.

Background Human immunodeficiency virus/ acquired immune deficiency syndrome (HIV/AIDS) constitutes a major global public health concern. There are an estimated 237,000 people living with HIV in Myanmar with prevalence of 0.57%, the fourth highest in South East Asia region. Specialist Hospital Waibargi (SHW) is one of the 3 main hospitals in Myanmar for HIV care and support with a cohort of nearly 2000 patients. This study was performed in SHW to evaluate the pattern and hospital outcome of various opportunistic infections (OI) in HIV-infected patients which are the principal cause of morbidity and mortality. Methods We conducted a retrospective records review study involving 370 HIV-infected patients hospitalized from October 2018 to September 2019 (1-year period). Disseminated tuberculosis (TB) was defined by concurrent involvement in at least two noncontiguous organs or miliary TB in a chest radiograph. Suggested Mycobacterium avium complex (MAC) was defined by the presence of prolonged fever not responding to anti-TB treatment and presence of generalized lymphadenopathy, hepatosplenomegaly, and pancytopenia in patients with CD4 &lt;50 cells/mm3. Invasive fungal infection was defined by the presence of diffuse infiltrates on chest radiograph and/or generalized lymphadenopathy, hepatosplenomegaly, and pancytopenia with a response to antifungal therapy. Frequencies of individual OI were expressed as percentages. Results Among 370 patients, antiretroviral therapy (ART) was initiated in 150 patients during admission, 153 patients were already on ART (first-line/second-line/third-line/ default and restart patients), 67 were about to be initiated at a follow-up visit and 9 were defaulters. The mean age was 38.2 ± 11 years, 224 male and 146 female patients were admitted (ratio 1.5:1). Mean CD4 is 111 cells/mm3 (range 4–627 cells/mm3). In total, 322 patients (87%) had CD4 &lt;350 cells/mm3. A total of 823 OI occurred in 370 patients. One hundred and twenty-nine patients had ≥ 2 OI. Among 823 episodes, pulmonary TB accounted 32.8% (270 patients) with 13% confirmed cases including 12 multi-drug-resistant cases. Extrapulmonary TB was 22% including 48 TB meningitis cases. Disseminated TB was found in 15.3%. The rest were sepsis (19.6%), acute gastroenteritis (4%), cryptococcal meningitis/cryptococcaemia (3%), Pneumocystis jiroveci pneumonia (PCP) (3.2%), skin fungal infection (4%), invasive fungal infection (4%), esophageal candidiasis (2.3%), Cytomegalovirus retinitis (0.6%), suggested MAC (1.7%), cerebral toxoplasmosis (0.7%), progressive multifocal leukoencephalopathy (0.8%), encephalitis (0.7%), Herpes zoster infection (0.6%). Eighty-six hospitalized patients died with a mortality rate of 23.2% mostly due to disseminated TB or fungal infection, PCP, sepsis, cryptococcal meningitis, and immune reconstitution inflammatory syndrome. The mean duration of hospitalization was 14 ± 11 days. Sixteen children (age 12–22 years) with CD4 &lt;350 cells/mm3 were included, half were infected congenitally and mortality was 50% mostly due to disseminated TB and sepsis. Conclusion Even in the test and treat era of ART, most HIV-infected patients in the study were late presenters with advanced disease. It highlights the importance of increasing testing awareness in the community and eliminating mother to child transmission. TB was the commonest OI among HIV-infected patients and early TB diagnosis, anti-TB treatment, good adherence, and latent TB prophylaxis are the major tools to improve HIV/TB-related morbidity and mortality.