Efficacy and safety of scorpion antivenom plus prazosin compared with prazosin alone for venomous scorpion (Mesobuthus tamulus) sting: randomised open label clinical trial

Objective Envenomation by Mesobuthus tamulus scorpion sting can result in serious cardiovascular effects. Scorpion antivenom is a specific treatment for scorpion sting. Evidence for the benefit of scorpion antivenom and its efficacy compared with that of commonly used vasodilators, such as prazosin, is scarce. We assessed the efficacy of prazosin combined with scorpion antivenom, compared with prazosin alone, in individuals with autonomic storm caused by scorpion sting

Newer onset of diabetes mellitus and thyroid dysfunction in COVID-19: Study from rural India

Background: Cytokine and bardykine storm plays important role in then pathogenesis of COVID-19 diseses, as result there are raised inflammatory markers and blood sugar. Patients and Method: Patient with RTPCR positive with signs and symptoms of COVID-19 were investigated for fasting and postprandial blood sugar and glycoted hemoglobin percentage, inflammatory markers TSH and Covid antibodies. Result: All the 17 cases detected newly onset of diabetes with normal HBA1c and raised thyroid stimulating hormones in five cases. Significant raised levels of inflammatory markers and D-diamer. All cases showed bilateral pneumonias in the lungs. Conclusion: Newer onset of diabetes mellitus due to COVID-19 disease should be mangled with insulin therapy

RBC acetyl cholinesterase: A poor man’s early diagnostic biomarker for familial alzheimer’s and Parkinson’s disease dementia

Objective: Analysis of red blood cell acetyl cholinesterase (AChE) in a familial Alzheimer’s diseases (AD) Parkinson’s disease dementia (PDD) and their first generation. Setting: General hospital, Mahad district, Raigad. Patients and Methods: Clinically diagnosed patients of AD and PDD and their asymptomatic relatives. Their blood was collected in EDTA tube and transferred to laboratory at Mumbai. Result: Median red blood cell (RBC) cholinesterase levels amongst PDD, their first generation asymptomatic relatives, familial AD, asymptomatic relatives of AD, healthy controls, farmers exposed to pesticides (positive control) and other neurological condition without dementia (hypertension with TIA 1, sub-dural hematoma 2, hypothyroid 1, non-familial unilateral parkinsonism without dementia 3, writers cramps 2, hyponitremia 1 and cerebral palsy with non-fluent aphasia 1). Median values of RBC AChE were 19086.78 U/L, 15666.05 U/L, 9013.11 U/L, 7806.19 U/L, 14334.57 U/L, 9785.05 U/L and 13162.60 U/L, respectively. As compared to controls, RBC AChE levels were statistically significant among PDD (P = 0.004) and significantly lowered among familial AD patients (P = 0.010), relatives of patients (P = 0.010). Interpretations: Below the normal RBC AChE level is a potential biomarker in asymptomatic relatives of familial AD patients. RBC AChE is raised than normal level in patients suffering from PDD, where AChE inhibitors are helpful. However, RBC AChE level below the normal where AChE inhibitor may not be effective

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

Profile of Vitamin D in patients attending at general hospital Mahad India

Background: Despite abundant sunshine, Vitamin D deficiency is prevalent in urban India. However, reports on analyzing Vitamin D status from rural Indian population are scanty. Here, we have evaluated Vitamin D status in patients attending outpatient department (OPD) in a rural Indian hospital setting. Methods: A hospital-based cross-sectional study was conducted at a secondary level rural hospital in patients attending medicine OPD. After obtaining informed consent, demographic information was collected from consecutive adult patients along with 3 ml blood sample for Vitamin D analysis using electro chemiluminescene on cobas elecys E411 fully automated system. Vitamin D levels were compared across various groups by using Mann–Whitney or Kruskal–Wallis tests, and multiple linear regression analysis was performed to identify the predictors of Vitamin D level. Results: A total of 640 patients were enrolled in the study, and the prevalence of Vitamin D deficiency (<20 ng/ml) was found to be 65.4% with 95% confidence interval of 61.7–69.1%. On univariate analysis, Vitamin D levels were statistically significantly lower among younger age group, those who have dark complexion, wearing Burkha (veil), and those who were not adequately exposed to sunlight. After multiple linear regressions, dark complexion, wearing Burkha, inadequate exposure to sunlight, and presence of diabetes were identified as statistically significant predictors of Vitamin D deficiency. Conclusion: We report a high prevalence of Vitamin-D deficiency in patients attending medicine OPD. Thus, patients with generalized complaints may be evaluated for serum Vitamin D levels

Scorpion envenomation

Every year, more than 1 million cases of scorpion envenomation are reported worldwide. Although the resultant mortality is lower than that from snake envenomation, there is substantial morbidity and, among children, a risk of death. Almost all systemic scorpion envenomation causes pain at the site of the sting. A mixed autonomic excitation (neuroexcitatory) syndrome that is unique to scorpions follows; the syndrome varies in type and severity according to the type of scorpion. In addition, a cytotoxic envenomation syndrome has been reported in areas of Iran in which Hemiscorpius lepturus is endemic

Tourniquet on a 43-year-old woman presenting at a rural health post in Nepal.

<p>First-aid methods applied throughout South Asia are largely inadequate. Tourniquets in particular can have deleterious effects. This patient consulted after being bitten by a nonvenomous rat snake (<i>Ptyas mucosa</i>) that she had killed and brought for identification. After reassurance, local treatment, and observation, she was uneventfully discharged from the health post. <i>Image credit: E. Alirol</i>.</p

“Broken neck” sign observed in a 14-year-old girl bitten by a Russell's viper in India.

<p>Envenoming by cobras, kraits and—in some areas—by Russell's viper frequently leads to progressive descending paralysis. Looking for the broken neck sign, which is caused by paralysis of the neck flexor muscles, should be part of the routine clinical assessment of patients. In this case, neuroparalysis persisted for five days despite antivenom treatment, but without progression toward respiratory failure. <i>Image credit: H. S. Bawaskar</i>.</p