BackgroundCurrently, there is inadequate evidence on which to base clinical management of neurotoxic snakebite envenoming, especially in the choice of initial antivenom dosage. This randomised controlled trial compared the effectiveness and safety of high versus low initial antivenom dosage in victims of neurotoxic envenoming.Methodology/ Principal findingsThis was a balanced, randomised, double-blind trial that was conducted in three health care centers located in the Terai plains of Nepal. Participants received either low (two vials) or high (10 vials) initial dosage of Indian polyvalent antivenom. The primary composite outcome consisted of death, the need for assisted ventilation and worsening/recurrence of neurotoxicity. Hourly evaluations followed antivenom treatment. Between April 2011 and October 2012, 157 snakebite victims were enrolled, of which 154 were analysed (76 in the low and 78 in the high initial dose group). Sixty-seven (43·5%) participants met the primary outcome definition. The proportions were similar in the low (37 or 48.7%) vs. high (30 or 38.5%) initial dose group (difference = 10·2%, 95%CI [-6·7 to 27·1], p = 0·264). The mean number of vials used was similar between treatment groups. Overall, patients bitten by kraits did worse than those bitten by cobras. The occurrence of treatment-related adverse events did not differ among treatment groups. A total of 19 serious adverse events occurred, including seven attributed to antivenom.ConclusionsThis first robust trial investigating antivenom dosage for neurotoxic snakebite envenoming shows that the antivenom currently used in Nepal performs poorly. Although the high initial dose regimen is not more effective than the low initial dose, it offers the practical advantage of being a single dose, while not incurring higher consumption or enhanced risk of adverse reaction. The development of new and more effective antivenoms that better target the species responsible for bites in the region will help improve future patients’ outcomes.Trial registrationThe study was registered on clinicaltrials.gov (NCT01284855) (GJ 5/1)

Background & Objectives: Hypertension and Diabetes Mellitus are both major modifiable risk factors leading to premature death due to cardiovascular and cerebrovascular diseases. Therefore, early diagnosis and treatment are must to reduce morbidity and mortality due to following diseases. Therefore authentic data on these issues are of great importance. The aim of this study was to address this gap and create awareness regarding essence of control of Diabetes and Hypertension among political cadres of Nepal as they play major role in policy making. Materials & Methods:A descriptive cross-sectional study in the political cadres of Nepal was conducted at Pragya Bhawan, Kathmandu on 4th March, 2012 where delegates attended their 3rd National assembly. Standard criteria were used to describe both Hypertension and Diabetes and their respective goals. Awareness and treatment were based on self-report. Results: A total of 291 subjects were included in the study. The prevalence of hypertension was 44.32% while that of Diabetes was 18.56%. The current blood pressure of the study population was 50% within normal range and 50% of them was above normal range, body mass index of 35% was normal and rest was above normal range. 15% of the study population was known diabetic while 33% was known hypertensive. More than 50% of known diabetics had poor control over blood sugar and 72% of the known hypertensive had poor blood pressure control. Conclusion: The scenario of hypertension and diabetes control among the political cadres is not up to the mark. Most of those already having the disease have poor control of blood pressure and blood sugar level. From this, the situation obviously seems more warning in general population and needs well-designed assessment.

Background: Snake bites are well-known medical emergencies requiring hospital admission. Krait and Cobra are common snakes leading to envenomation in Nepal. Timely identification of the envenomation leads to prompt treatment and decrease the morbidity and mortality. We aimed to study the clinical profile and outcome of patients with snake envenomation at Bharatpur Hospital, Nepal. Materials and Methods: The Study was a descriptive cross-sectional study conducted in the Department of Medicine in Bharatpur hospital from April 2018 to September 2018. The patients of snake bites admitted with signs of neurological, hematological, local or regional envenomation were enrolled in the study. Clinical profile, duration of hospital stay and outcomes were noted and analyzed in the study. Results: Out of 63 patients of snake bite, majority of snakes responsible for envenomation was due to Krait (38.1%) followed by Cobra (9.5%) and only 4 cases (6.3%) were due to Viper envenomation. The most common sign of presentation was Ptosis (69%) followed by difficulty in protruding tongue (42.9%). Mean number of Anti Snake Venom (ASV) vials required was 26.03. The mean duration of hospital stay in neuroparalytic cases was 46.8 hours while 60.5 hours in hematotoxic cases. There was a fatality rate of 11.1%. Conclusion: Snakebite is a common life-threatening emergency in the study area. Majority of the patients were victims of Krait or Cobra bite. Early administration of ASV prevents respiratory paralysis after neuroparalytic snakebite. Timely intubation and mechanical ventilation in respiratory paralysis cases is life saving. The development of new and more effective Antivenom that better targets the species responsible for bites in the region would help in improving future patients’ outcome. Key words: Envenomation, snakebites, emergency, Clinical profile .