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Snake Bite PDF
Snake Bite PDF
Acknowledgment
We are thankful to Director Board of Secondary
Education, Baqai Medical University and all the school
teachers who supported us in every stage of the study.
References
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Special Communication
A Contextual Approach to Managing Snake Bite in Pakistan: Snake Bite Treatment
with Particular Reference to Neurotoxicity and the Ideal Hospital Snake Bite Kit
Naeem A Quraishi1, Huma I. Qureshi2, Ian D Simpson3
Liaquat University of Medical and Health Sciences1, Jamshoro, Sindh, Pakistan Medical Research Centre.2,3
Abstract
Although the snakebite mortality numbers for
Pakistan are over estimated, snakebite remains a significant
problem of rural areas. Significant improvements are
possible with locally developed protocols incorporating the
latest research. The use of simple reliable diagnostic tools in
managing viperine envenomation and the introduction of
monitoring cycles based on physiological criteria can
greatly improve outcome. The acquisition by hospitals, even
the most basic, of inexpensive drugs and simple readily
improvisable equipment can dramatically improve patient
survival in neurotoxic, particularly cobra envenomation.
Basic hospitals can intervene in snakebite management and
this is essential if envenomed victims are to be treated early.
This paper makes recommendations as to the basic drug and
Vol. 58, No. 6, June 2008
Introduction
Pakistan has a long history of snake bite. As early as
1854, doctors in the area were investigating the burden of
snake bite and the 'deadly snakes of Sindh".1,2 Despite this,
little definitive information exists as to which species are
causing the bites or the geographical range of many of the
species. A prime example is the cobra family. The Asiatic
cobra or 'black cobra' is probably confined to the north of
Punjab and North West Frontier Province and yet the use of
the Sindhi term 'Karo' or black cobra for the cobra in Sindh
adds confusion as to which species are present in which
area.
Much of Pakistan medical education is based on
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3.
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pregnancy.13
ASV should be given only when the criteria for
administration are present. If a patient presents after many
days, complaining of snakebite, a 20WBCT should be
carried out. In the case of incoagulable blood, ASV should
be given. ASV should be given as late as the 20WBCT
indicates that it is required by demonstration of
incoagulable blood.9
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3.
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4.
5.
6.
7.
References
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Imlach CJF. Mortality from snake-bite in the province of Sind. Trans Bombay
Med Phys Soc. Bombay Education Society Press. 1857; III:98-106.
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Vidal CS. A list of the venomous snakes of north Kanara: with remarkes as to
the imperfections of existing records of distribution of snakes and facts and
statistics showing the influence of Echis carinata on the death rate of the
Bombay presidency. J Bombay Nat Hist Soc. 1890;5:64-71.
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Auerbach PS, Norris RL. Disorders Caused by Reptile Bites and Marine
Animal Exposures. In: Harrison's Principles of Internal Medicine 16th Ed.
Kaspar DL, Fauci AS, Braunwald E, et al. McGraw-Hill New York. 2005
2593-2600.
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Benjamin N, Rawlins M, Vale JA. Drug Therapy and Poisoning. In: Kumar P,
Clark M. eds. Kumar and Clark Clinical Medicine. 5th ed. United Kingdom:
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Suleman MM, Shahab MA, Rab MA. Snake Bite in the Thar Desert. J Pak
Med Assoc 1998; 48: 306-8.
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Khan MS. Venomous Terrestrial Snakes of Pakistan and Snake Bite Problem.
In: Gopalakrishnakone P, Chou P eds. Snakes of Medical Importance. L.IST
National University of Singapore. 1990, pp 419-45.
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Hazra A. Poisonous Snake Bites in India. Community Dev. Med. Unit Ration.
Drug Bull 2003;30: 1-12.
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Sengupta S.R, Tare TG, Sutar NK, Renapurkar DM. Ecology and distribution
of Echis carinatus snakes in Deogad Taluka and other areas of Maharashtra
State, India. J Wild Med. 1994;5:282-86.
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Kochar DK, Tanwar PD, Norris RL, Sabir N, Nayak KC, Agrawal TB, et al.
Rediscovery of Severe Saw Scaled Viper (Echis sochureki) Envenoming in
the Thar Desert Region of Rajasthan, India. Wild Environ Med. 2007; 18: 7585.
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Watt G, Theakston RD, Hayes CG, Yambao ML, Sangalang R, Ranao CP, et
al, Positive response to edrophonium in patients with neurotoxic envenoming
by cobras (Naja naja Philippinensis) N Eng J Med 1986; 23: 1444-8.
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Simpson ID. Snakebite Management in India, the First Few Hours: A Guide
for Primary Care Physicians. J. Indian Med Assoc 2007; 105: 324-35.
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Mal R. A Study of Snake Bite Cases. J Pak. Med. Assoc. 1994; 44: 289.
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Zafar J, Aziz S, Hamid B, Qayyum A, Alam MT, Qazi RA. Snake Bite
Experiences at Pakistan Institute of Medical Sciences. J Pak Med Assoc 1998;
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Seir F. Snake Bite Cases in CMH Bahawalpur. Pak Armed Forces Med J 2001;
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Simpson ID, Norris RL. Snake Antivenom Product Guidelines in India: The
Devil is in the Details. Wilderness and Environmental Medicine. 2007;18:
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McLean-Tooke AP, Bethune CA, Fay AC, Spickett GP. Adrenaline in the
treatment of anaphylaxis: what is the evidence? BMJ 2003; 327: 1332-35
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Ansari AK, Sheikh SA. Management of Vipride Snake Bite. Pak Armed
Forces Med J 2000; 50: 26-8.
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Premawardhema AP, de Silva CE, Fonseka MM, Gunatilake SB, de Silva HJ,
Low dose subcutaneous adrenaline to prevent acute adverse reactions to
Special Communication
Helicobacter pylori in dental plaque and gastric mucosa: Correlation revisited
Saima Chaudhry1, Hafiz Aamer Iqbal2, Ayyaz Ali Khan3, Mateen Izhar4, Arshad Kamal Butt5, M. Waheed Akhter6,
Faisal Izhar7, Kamran Masood Mirza8
Department of Oral Health Sciences1,7,8, Shaikh Zayed Federal Postgraduate Medical Institute, Department of Oral and Maxillofacial Surgery2,
SIMS/Services Hospital, Department of Oral Health Sciences3, Department of Microbiology4, Department of Gastroenterology5, Shaikh Zayed Federal
Postgraduate Medical Institute, School of Biological Sciences6, University of the Punjab, Lahore.
Abstract
Helicobacter pylori (H. pylori) related gastric
infection is highly prevalent in developing countries.
Prevalence of bacterium in dental plaque from these
regions is also reported to be high, but association between
simultaneous colonization of H. pylori in both these sites
has not been established yet. Aim of this paper is to review
possible association between simultaneous oral and gastric
H. pylori colonization in dyspeptic patients. Pertinent
literature was reviewed and all available evidence
collected from Medline and PakMedinet. Studies
conducted in the developing world show conflicting
results. Some report a positive relation between oral and
gastric H. pylori colonization while others deny any
association. This may be due to the population sampled or
methodology applied. Further studies are recommended to
confirm the association between concurrent presence of H.
Introduction
The presence of Helicobacter pylori (H. pylori) in
humans is recognized as a chronic infection, which in most
cases persists indefinitely.1 H. pylori is a gram negative,
motile, microaerophilic, rod-shaped bacterium that
colonizes the human stomach. It lives beneath the gastric
mucous layer adjacent to gastric epithelial cells.2 It is a
major human gastric pathogen responsible for gastritis and
peptic ulcer disease.3 It has also been designated a type I, or
definite, carcinogen by World Health Organization, as it is
associated with the development of gastric adenocarcinoma,
the second most commonly diagnosed fatal cancer
worldwide.4 H. pylori is also associated with gastric
MALTomas.3
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