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Aims of MHSR Journal

• To serve as an important medium for the publication of original research in the field of medical science and health research, thus filling gaps in health knowledge for effective utilization of research findings
• To impart current medical knowledge and updated scientific information obtained from research to health professionals for better and appropriate health care management
• To disseminate recent basic, applied and social research findings among health personnel of different strata for enhancing worldwide health development

Archives   2003

Myanmar   Health   Sciences   Research   Journal

Volume   15,  Number   1-3

TITLE:   Evaluation of pre hospital antivenom in management and outcome of Russell's viper (Daboia russelii siamensis) bite cases admitted to Taungdwingyi Hospital.
AUTHOR:   Tun Pe; Aye Aye Myint; Khin Aye Kyu; Sann Mya
SOURCE:   Myanmar Health Sciences Research Journal. 2003; 15(1-3): 1-5
ABSTRACT:   Evaluation of pre hospital antivenom in management and outcome of 61 Russell's viper (Daboia russelii viconensis) bite cases admitted to Taungdwingyi Hospital from August 1996 to October 1997 was carried out, The first dose of antivenom (1-4 ampoules) was given at rural health centers at 1.10h ± 13 min. after the bite and remaining 0-3 ampoules totaling 4 ampoules at admission 3h ±. 23min after the first dose. Majority of the cases (75%) received liquid antivenom. Venom antigen was not detected in admission post antivenom samples in 23% moderate envenoming in 47% and severe envenoming in 30%. A venom level of 10-40ng/ml was detected at 5h in moderately envenomed cases given 1-2 ampoules of antivenom within 3h after the bite and 10-80ngiml in severe envenomed cases within 6h after 1-5 ampoules of antivenom. Delay in venom clearance is probably related to quality and dose of liquid antivenom used. Five out of 24 moderately envenomed cases developed severe envenoming and complications. Systemic complications developed in 5 out of 9 severe envenomed cases (5 fatality) given 1-2 ampoules antivenom within 3h and second dose within 5h and in 3 out of 9 of the severe envenomed cases (3 fatality) giver 3-5 ampoules antivenom. It is highlighted that a single early bolus dose of 4 ampoules of antivenom is more effective in preventing onset of systemic complications and fatality than giving the total in two divided doses. Since early administration of antivenom in the field plays an important role in management of snakebite, arrangement should he made for the availability of antivenom at rural health centers and local health workers should be trained and legislated to give intravenous antivenom according to the guidelines after assessing degree of envenoming by performing clotting test. Rapid quantitation of venom antigen by dipstick will be helpful in the field for selection and estimation of antivenom dose.
SUBJECT HEADINGS:   Snake Bites. Russell's Viper. Antivenins.
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