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J Family Med Prim Care
J Family Med Prim Care
JFMPC
J Family Med Prim Care
Journal of Family Medicine and Primary Care
2249-4863
2278-7135
Wolters Kluwer - Medknow India

JFMPC-13-3445
10.4103/jfmpc.jfmpc_234_24
Letter to Editor
Some concerns on ‘clinico-epidemiological profile and outcome of snakebite patients presented to a teaching institute – A descriptive retrospective review’
Mohanty Chitta R. 1
Barik Amiya K. 2
Radhakrishnan Rakesh V. 3
Samuel Stephen P. 4
1 Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
3 College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
4 Sr. Consultant and Sr. VP, India Clinical Research and Medical Affairs, Ophirex, Inc, USA
Address for correspondence: Dr. Chitta R. Mohanty, Department of Trauma and Emergency, All India Institute of Medical Science, Bhubaneswar -751 019, Odisha, India. E-mail: drchitta8@gmail.com
8 2024
26 7 2024
13 8 34453446
14 2 2024
06 3 2024
07 3 2024
Copyright: © 2024 Journal of Family Medicine and Primary Care
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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pmcDear Editor,

We read the article authored by Kumar et al.,[1] recently published in your esteemed journal, with great interest. We would like to highlight some concerns and suggestions.

In this retrospective, observational, descriptive study, the authors have tried to highlight the clinico-epidemiological pattern and the outcome following the snake bite in the southern part of India. Calculating the envenomation severity without a validated score such as snake bite severity score (SSS) is inaccurate and is a major concern here.[23] The SSS uses other parameters like respiratory, hematological, neurological, renal, and gastro-intestinal symptoms to grade the severity of envenomation accurately.[23] In this study, only local signs without any information on other systems have been used, whereas a comparative description of local and systemic symptoms of envenomation and complications could have given a better picture of the clinical manifestations of envenomation [especially for a bite by elapid (cobra and krait) and Viperidae family (Russel’s viper, saw-scaled viper)].[34]

As most of the bites were neurotoxic, detailed information on the percentage of patients who required an intensive care unit (ICU) and mechanical ventilation and an objective measurement of the severity of neuroparalysis using head lift and/or single breath count would have better represented the outcome parameters.[134] Similarly, in the case of viper bite, the information on the percentage of patients who developed acute renal failure and required dialysis is missing.[1] In local manifestations, compartment syndrome, which is an important complication of cobra and viper bite, is not mentioned. Krait bite is most common as per the study data,[1] but krait bite occurs mainly in India from July to October so that a seasonal distribution could have added better representation.[5] In addition, kraits have small fangs and are not known to develop obvious local signs or symptoms. Therefore, it would be prudent to utilize SSS to capture neuroparalysis and autonomic neuropathy.

In 41 cases, species could not be identified.[1] However, the readers would be interested to know how many of them had abnormal 20-minute whole blood clotting test (WBCT), PT, aPTT, INR, and Hb (hemolysis), which could reflect the hemotoxic manifestations of envenomation.[45] In the case of patients referred from other remote areas, data on first aid measures undertaken before reaching the study hospital and the number of hospitals visited before reaching the ED, mode of transport, and reason for the delay in reaching are important epidemiological factors to explore as they reflect the need for awareness and community empowerment to reduce the burden of mortality and morbidity following snake bite.[5] Similarly, information on the number of ASVs received before presenting to the study center and the time for snake bite to the administration of ASV (needle time) could have added more authenticity to the manuscript as it can affect the final clinical outcome.[345]

To conclude, we hope that the points mentioned earlier will be informative for the readers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
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1 Kumar SM Shreekrishna HK Singi Y Clinico?epidemiological profile and outcome of snakebite patients presented to a teaching institute –A descriptive retrospective review J Family Med Prim Care 2024 13 151 6 38482274
2 Dart RC Hurlbut KM Garcia R Boren J Validation of a severity score for the assessment of crotalid snakebite Ann Emerg Med 1996 27 321 6 8599491
3 Carter RW Gerardo CJ Samuel SP Kumar S Kotehal SD Mukherjee PP The BRAVO clinical study protocol: Oral varespladib for inhibition of secretory phospholipase A2 in the treatment of snakebite envenoming Toxins (Basel) 2022 15 22 doi: 10.3390/toxins15010022 36668842
4 Warrell DA Guidelines for the Management of Snake Bites in the South-East Asia Region World Health Organization 2010 1 162
5 Mitra S Agarwal A Shubhankar BU Masih S Krothapalli V Lee BM Clinico-epidemiological profile of snake bites over 6-year period from a rural secondary care centre of Northern India: A descriptive study Toxicol Int 2015 22 77 82 26862265
