Snake Bite in South Asia: A Review

Snake bite is one of the most neglected public health issues in poor rural communities living in the tropics. Because of serious misreporting, the true worldwide burden of snake bite is not known. South Asia is the world's most heavily affected region, due to its high population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs. Despite increasing knowledge of snake venoms' composition and mode of action, good understanding of clinical features of envenoming and sufficient production of antivenom by Indian manufacturers, snake bite management remains unsatisfactory in this region. Field diagnostic tests for snake species identification do not exist and treatment mainly relies on the administration of antivenoms that do not cover all of the important venomous snakes of the region. Care-givers need better training and supervision, and national guidelines should be fed by evidence-based data generated by well-designed research studies. Poorly informed rural populations often apply inappropriate first-aid measures and vital time is lost before the victim is transported to a treatment centre, where cost of treatment can constitute an additional hurdle. The deficiency of snake bite management in South Asia is multi-causal and requires joint collaborative efforts from researchers, antivenom manufacturers, policy makers, public health authorities and international funders

The impact of pathological fractures on therapy outcome in patients with primary malignant bone tumours

The primary objective of this study was to investigate the implications of pathological fractures on therapy outcome in patients with primary malignant bone tumours and to determine whether limb salvage can be safely performed. A retrospective analysis of 447 patients with primary malignant bone tumours, treated between 1985 and 2005, was performed. Multivariate Cox regression analysis was used to investigate the influence of pathological fractures and further independent variables on survival rate. In 52 of the 447 patients, the primary malignant bone tumour was complicated by a pathological fracture. These fractures were more common in malignant fibrous histiocytoma (MFH) of the bone and in the tumour stages IIa/b and III. Ablative surgery was performed in ten patients and limb salvage surgery in 42 patients. The mortality risk for patients with pathological fractures was significantly increased by a factor of 1.82 (p = 0.015), and overall duration of survival was significantly lower in the fracture group, with a median of 6.2 years (p < 0.00001). In univariate and multivariate analysis, fracture, higher tumour stages and resection margins remained a significant predictor of worse survival. Overall survival, rate of local recurrence and distant metastases were not affected by the type of surgical treatment selected; there was no difference between the patients who underwent limb salvage and those who underwent an amputation. Pathological fracture in patients with primary malignant bone tumours is a predictor of worse survival and significantly increases mortality risk. Reconstructive surgery did not influence the survival rate, showing that limb salvage therapy is safe when adequate resection margins are achieved

Hits Close to Home: Repeated Persecution of King Cobras (Ophiophagus hannah) in Northeastern Thailand

Protected areas are often promoted as an important solution to preserving biodiversity. However, permeable edges can undermine the effectiveness of preserves because animals may move into adjacent human-dominated unprotected areas. We investigated attitudes toward, and sources of mortality of, a far-ranging apex predator, the king cobra (Ophiophagus hannah; Cantor 1836), in a biosphere reserve in northeastern Thailand. Our questionnaire revealed marked fear of snakes and hostility toward king cobras. Using radiotelemetry, we followed 23 king cobras over a 4-year period, during which time we documented the mortality of 14 individuals. We considered 10 of the deaths to be anthropogenic in origin, including road mortality, pollution, fish traps, and direct persecution; these deaths disproportionately occurred in unprotected areas. Our results highlight how dangerous human-dominated landscapes are for king cobras. Because king cobras move long distances and maintain large home ranges, it is likely that successful conservation of the species cannot be satisfactorily met by protected areas alone; a more holistic, education-focused conservation strategy is required. We stress the importance of a human dimensions approach that leads toward greater understanding of human attitudes toward king cobras, and snakes in general, combined with ecological research for more effective conservation.Wildlife Reserves Singapore; National Science and Technological Development Agency, ThailandOpen access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]