A prospective study of snakebite in a tertiary care hospital in south-western Nepal.

BACKGROUND: Snakebite is a neglected public health issue in Nepal. We aimed to characterize patients with snake envenoming admitted to hospital in south-western Nepal. METHODS: This was a prospective cohort study of 476 snakebite patients admitted to Bheri Hospital from May to December 2017. Data were collected on patient demographics, bite circumstances, snake type, treatment-seeking behavior, clinical effects, complications and treatment. RESULTS: There were 139/476 (29%) patients with clinical features of envenomation and 10 deaths (8%), of which six were prehospital deaths; 325/476 (68%) patients used non-recommended prehospital first aid, including 278 (58%) who applied a tourniquet and 43 (9%) consulting traditional healers. Median time to hospital arrival was 1.5 (IQR: 0.8-4) h. Also, 127 envenomated patients (91%) developed neurotoxicity and 12 (9%) hemotoxicity, while 124 patients (89%) received antivenom, with a median dose of 10 (4-30) vials. Three patients developed anaphylaxis following antivenom administration; 111 of 139 (80%) cases were admitted to the ICU and 48 (35%) were intubated. Median length of hospital stay for all cases was 0.5 (IQR: 0.5-1.2) d, but it was 2.2 (IQR: 1.5-3.8) d for envenomated cases. CONCLUSIONS: The majority of snakebite patients used non-recommended first aid or attended traditional healers. Almost one-third of patients developed systemic envenomation and required antivenom. The case fatality rate was high, but many died prior to arriving in hospital.

Rabies Elimination: Is It Feasible without Considering Wildlife?

Rabies is a vaccine-preventable fatal viral disease that is zoonotic in nature. In this article, we provide a justification why the agreement of the World Health Organization (WHO), the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), and Global Alliance for Rabies Control (GARC) on The Global Strategic Plan to End Human Deaths from Dog-mediated Rabies by 2030 should also include a more holistic approach and ecologic views.

Ethnomedicinal plants used by yak herders for management of health disorders.

AIM: The aim of the study was to document the indigenous ethno-botanical knowledge of the transhumant nomads of Mustang, Nepal, a representative settlement in the Himalayan highland. METHODOLOGY: A study was carried out during a direct field visit to collect plants, consisting of a semi-structured questionnaire and personal interviews. Both fresh and dried herbs, plants parts, and fungus were collected as far as possible. RESULTS: The present study identified 51 medicinal plants and 2 funguses that were used for 47 different ailments in the medicinal practices of the nomadic tribes of Lower Mustang, Nepal. Most of the medicines were prepared as juice (22.64%) or powder (49.05%) and administered orally. Roots (23%) and leaves (28%) were the most frequently used parts of the plants while prayer-laced ties were commonly applied in sheds and housing areas. CONCLUSION: This study has shown that the transhumant pastoralist nomadic communities have their own traditional ethno-botanical medicines that remain cost effective and the method of choice for management of health disorders and is passed down through oral traditions under the guidance of an herbal practitioner. There is a need for such practices to be scientifically validated, with respect and inclusion into sustainable veterinary medicine to support these remotely located communities.