Medico-legal significance of the identification of offending snake in a fatal snake bite: A case report

Silva, Anjana; Gamlaksha, Dayal; Waidyaratne, Dhananjaya L.

doi:10.1016/j.jflm.2013.09.009

Cited by 14 publications

(8 citation statements)

References 7 publications

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“…Ignorant, negative, and fearful people who tend to encourage the killing of snakes put themselves at the risk of envenomation. Pronounced confusion in differentiating venomous and non-venomous snakes, even among teachers and students in Nepal, teachers in Kenya [54] and medical service providers in Sri Lanka [72] disclose the need for more effective education in southern Nepal and elsewhere with similar circumstances.…”

Section: Discussionmentioning

confidence: 99%

Public perceptions of snakes and snakebite management: implications for conservation and human health in southern Nepal

Pandey

Devkota

et al. 2016

J Ethnobiology Ethnomedicine

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BackgroundVenomous snakebite and its effects are a source of fear for people living in southern Nepal. As a result, people have developed a negative attitude towards snakes, which can lead to human-snake conflicts that result in killing of snakes. Attempting to kill snakes increases the risk of snakebite, and actual killing of snakes contributes to loss of biodiversity. Currently, snake populations in southern Nepal are thought to be declining, but more research is needed to evaluate the conservation status of snakes. Therefore, we assessed attitudes, knowledge, and awareness of snakes and snakebite by Chitwan National Park’s (CNP) buffer zone (BZ) inhabitants in an effort to better understand challenges to snake conservation and snakebite management. The results of this study have the potential to promote biodiversity conservation and increase human health in southern Nepal and beyond.MethodsWe carried out face-to-face interviews of 150 randomly selected CNP BZ inhabitants, adopting a cross-sectional mixed research design and structured and semi-structured questionnaires from January–February 2013.ResultsResults indicated that 43 % of respondents disliked snakes, 49 % would exterminate all venomous snakes, and 86 % feared snakes. Farmers were the most negative and teachers were the most ambivalent towards snakes. Respondents were generally unable to identify different snake species, and were almost completely unaware of the need of conserve snakes and how to prevent snakebites. Belief in a snake god, and the ability of snakes to absorb poisonous gases from the atmosphere were among many superstitions that appeared to predispose negativity towards snakes of BZ residents.ConclusionPeople with predisposed negativity towards snakes were not proponents of snake conservation. Fear, negativity, ambivalence towards, and ignorance about, snakes and the need for snake conservation were strong indicators of the propensity to harm or kill snakes. It seems that if wanton killing of snakes continues, local snake populations will decline, and rare and endangered snake species may even become locally extirpated. Moreover, inappropriate perception and knowledge about snakes and snakebites may put BZ people at increased risk of venomous snakebite. Therefore, intensive, pragmatic educational efforts focused on natural history and ecology of snakes and prevention of snakebite should be undertaken in communities and at schools and universities.

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Section: Discussionmentioning

confidence: 99%

Public perceptions of snakes and snakebite management: implications for conservation and human health in southern Nepal

Pandey

Devkota

et al. 2016

J Ethnobiology Ethnomedicine

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“…Coagulation disorders induced by hemostatically active components found in the venom are followed by local and systemic hemorrhage and also by other common secondary effects such as hypotension, circulation microthrombi deposition and organ failure (Teixeira et al 2011;Suntravat et al 2011;Silva et al 2013;Harshavardhan et al 2013;Yamashita et al 2014 …”

Section: Introductionmentioning

confidence: 99%

Moojenactivase, a novel pro-coagulant PIIId metalloprotease isolated from Bothrops moojeni snake venom, activates coagulation factors II and X and induces tissue factor up-regulation in leukocytes

et al. 2015

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Coagulopathies following snakebite are triggered by pro-coagulant venom toxins, in which metalloproteases play a major role in envenomation-induced coagulation disorders by acting on coagulation cascade, platelet function and fibrinolysis. Considering this relevance, here we describe the isolation and biochemical characterization of moojenactivase (MooA), a metalloprotease from Bothrops moojeni snake venom, and investigate its involvement in hemostasis in vitro. MooA is a glycoprotein of 85,746.22 Da, member of the PIIId group of snake venom metalloproteases, composed of three linked disulfide-bonded chains: an N-glycosylated heavy chain, and two light chains. The venom protease induced human plasma clotting in vitro by activating on both blood coagulation factors II (prothrombin) and X, which in turn generated α-thrombin and factor Xa, respectively. Additionally, MooA induced expression of tissue factor (TF) on the membrane surface of peripheral blood mononuclear cells (PBMC), which led these cells to adopt pro-coagulant characteristics. MooA was also shown to be involved with production of the inflammatory mediators TNF-α, IL-8 and MCP-1, suggesting an association between MooA pro-inflammatory stimulation of PBMC and TF up-regulation. We also observed aggregation of washed platelets when in presence of MooA; however, the protease had no effect on fibrinolysis. Our findings show that MooA is a novel hemostatically active metalloprotease, which may lead to the development of coagulopathies during B. moojeni envenomation. Moreover, the metalloprotease may contribute to the development of new diagnostic tools and pharmacological approaches applied to hemostatic disorders.

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“…Krait (Indian and Ceylon) usually bites at night in victims who sleeps on floor within small hut or houses in cultivated areas [3]. Krait bite usually does not produce visible fang marks or local reaction.…”

Section: Discussionmentioning

confidence: 99%

“…Krait bite usually does not produce visible fang marks or local reaction. Krait bite was further excluded due to presence of severe local signs and rapid progression to death [3]. Peculiar feature observed in this case was that the bite was found in breast in contrast to usual site of bite in lower limb and not commonly in upper limb [7].…”

Section: Discussionmentioning

confidence: 99%

Snake bite: Medico-legal significance

Raveendran

Vidanapathirana

2016

Medico-Legal J SL

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Introduction: Most of the snake bite deaths reported were due to delay in giving antivenom or non-availability of species specific antivenom and the relatives of deceased allege against doctors that proper care is not given. Forensic pathologist is expected not only to give cause of death but also give opinions about potential negligence in such cases. Case report: A middle aged woman died while being transported from a local hospital to a tertiary care hospital following a snake bite. She was brought to the hospital with symptoms suggestive of neurotoxin poisoning and anti-snake venom was given at the local hospital. The patient developed shortness of breath and she was transferred to a tertiary-care hospital for further ventilator support, but the patient was pronounced dead on the way after 2 hours of the bite. Bite mark with two fangs was found on left upper part of the breast. Inflammatory signs were found around the bite mark with necrosis and blister formation. Autopsy revealed no hematological manifestations. Conclusions: The COD was envenomation of neurotoxin due to cobra bite. The allegation of medical negligence may be challenged, because death could occur rapidly within 30 minutes to two hours in cobra bites and delay in transport may also have played a vital role especially being a rural area. Role of non-availability of species specific antivenom and efficacy of common anti snake venom should be further studied before giving opinions regarding potential negligence.

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Medico-legal significance of the identification of offending snake in a fatal snake bite: A case report

Cited by 14 publications

References 7 publications

Public perceptions of snakes and snakebite management: implications for conservation and human health in southern Nepal

Public perceptions of snakes and snakebite management: implications for conservation and human health in southern Nepal

Moojenactivase, a novel pro-coagulant PIIId metalloprotease isolated from Bothrops moojeni snake venom, activates coagulation factors II and X and induces tissue factor up-regulation in leukocytes

Snake bite: Medico-legal significance

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