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FN1Financial support: We were grateful for financial support for the project received from the Wellcome Trust (grants 052708/Z/97/Z and 079027/Z/06/Z), the Association of Physicians of Great Britain and Ireland, the Association of British Neurologists and the Deutsche Forschungsgemeinschaft (grant KU2328/1-1).
FN2Disclosure: All authors were actively involved in the planning and prosecution of the study and all have participated in the collection and analysis of data and the preparation of the manuscript. No author has any real or perceived conflicts of interest.
FN3Authors' addresses: M. A. Faiz, Dev Care Foundation, Dhaka, Bangladesh, E-mail: email@example.com. M. F. Ahsan, Department of Zoology, University of Chittagong, Chittagong, Bangladesh, E-mail: firstname.lastname@example.org. A. Ghose, Chittagong Medical College and Hospital, Chittagong, Bangladesh, E-mail: email@example.com. M. R. Rahman, Department of Medicine, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh, E-mail: firstname.lastname@example.org. R. Amin, M. Hossain, Dhaka Medical College and Hospital, Dhaka, Bangladesh, E-mail: email@example.com. M. N. U. Tareq, Chittagong General Hospital, Chittagong, Bangladesh, E-mail: firstname.lastname@example.org. M. A. Jalil, Department of Statistics, University of Dhaka, Dhaka, Bangladesh, E-mail: email@example.com. U. Kuch, Department of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany, E-mail: firstname.lastname@example.org. R. D. G. Theakston, Alistair Reid Venom Research Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, E-mail: email@example.com. D. A. Warrell, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom, E-mail: firstname.lastname@example.org. J. B. Harris, Medical Toxicology Centre and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom, E-mail: email@example.com.
- The American Society of Tropical Medicine and Hygiene
- Source: The American Journal of Tropical Medicine and Hygiene, Volume 96, Issue 4, Apr 2017, p. 876 - 884
oa Bites by the Monocled Cobra, Naja kaouthia, in Chittagong Division, Bangladesh: Epidemiology, Clinical Features of Envenoming and Management of 70 Identified Cases
We describe 70 cases of monocled cobra (Naja kaouthia) bite admitted to Chittagong Medical College Hospital, Bangladesh. The biting snakes were identified by examining the dead snake and/or detecting N. kaouthia venom antigens in patients' serum. Bites were most common in the early morning and evening during the monsoon (May–July). Ligatures were routinely applied to the bitten limb before admission. Thirty-seven patients consulted traditional healers, most of whom made incisions around the bite site. Fifty-eight patients experienced severe neurotoxicity and most suffered swelling and pain of the bitten limb. The use of an Indian polyvalent antivenom in patients exhibiting severe neurotoxicity resulted in clinical improvement but most patients experienced moderate-to-severe adverse reactions. Antivenom did not influence local blistering and necrosis appearing in 19 patients; 12 required debridement. Edrophonium significantly improved the ability of patients to open the eyes, endurance of upward gaze, and peak expiratory flow rate suggesting that a longer-acting anticholinesterase drug (neostigmine) could be recommended for first aid. The study suggested that regionally appropriate antivenom should be raised against the venoms of the major envenoming species of Bangladesh and highlighted the need to improve the training of staff of local medical centers and to invest in the basic health infrastructure in rural communities.
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