Background: Kumaon region of Uttarakhand has a wide array of snakes. According to national health profile 2016 report on state wise cases and death due to snake bite was 167 and 1 respectively in Uttarakhand 2015 (Jan- December).This led to enquire this statistical disparity in spite of high prevalence of snake bite cases. Aim: To asses treatment outcome of Snake bite victim in tertiary care setting. Material And methods: Outcome was assessed in terms of clinical status at the time of discharge and duration of hospitalization. Results: Dose range of anti snake venom (ASV) for all snake bite victim was 10 -20 vials. 86.36%% case recovered and 13.6% died. Conclusion:Timely appropriate dose of anti snake venom administration has led to better outcome for which transportation of snake bite victim to appropriate health facility with in golden hour is imperative.

Toxic epidermal necrolysis (TEN) is a rare and serious but life-threatening dermolytic cutaneous reaction characterized by diffuse and severe exfoliation and destruction of the epidermis of skin and mucosa due to immunological damage of the epidermis which can bring about sepsis and respiratory distress. Drugs are the most common inflicting agents in the generation of TEN. Among drugs, antiepileptics, antipsychotics, and sulfa-drugs are common causes of TEN. Valproate is one of the most common drugs prescribed for epilepsy, was found as causative agent in TEN in very few cases. Among sulfonamides, sulfamethoxazole is commonly used antibiotic which can cause TEN. The evidence-based treatment guidelines are lacking, so the best approach is to recognize and evade potential risk factors and to deliver intensive supportive care immediately to reduce morbidity and mortality. The aim of this case series is to focus on valproate and trimethoprim-sulfamethoxazole (TMP-SMX)-induced TEN, which are commonly used drugs. Here, we present a case series of TEN inflicted by TMP-SMX and sodium valproate in a 23-year-old female and 10-year-old boy, respectively, with successful recovery.

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