Dear Editor,
We read the article by Kumar et al.,[1] recently published in your esteemed journal, and it was of great interest to us. However, we want to highlight our concern and suggest few points that will add to the existing topic and will be of interest to the readers.
The authors have conducted a prospective study, but they have failed to incorporate important information regarding the snake bite (SB). Though the authors provide the symptoms of local, hematological, and neurological, information on other systems like pulmonary, gastrointestinal, and renal are lacking. They could have used a validated scoring system like the Snake-bite Severity Score (SSS) to grade the severity of envenomation.[2] The information on the anti-snake venom (ASV) (dose, vials administered, immediate and delayed complications) is missing.[3,4]
As per our experience, up to one-third of krait bite patients need emergency intubation and mechanical ventilation. However, the authors mentioned only five patients had respiratory paralysis and did not mention, how many patients required mechanical ventilation.[1] Moreover, there is no mention regarding intensive care unit (ICU) admission. The curiosity persists regarding the primary cause of death among three patients who died at the hospital.[1] As per our experience, the inability to administer timely and adequate anti-snake venom, leading to respiratory failure, is the primary cause. Data regarding laboratory investigations like complete blood count, coagulation profile, liver and renal function test, essential indicators of bite severity, anticipated complication, and prognosis could have been added.[2,5]
Kumar et al.[1] mentioned that snakes were identified in almost 51 patients. In a recent study by Bhatnagar R et al.,[3] only in 10% of the cases the species could be identified. Additionally, it is difficult for pediatric patients to identify the exact species of snakes, especially at night. Regarding the site of the bite, 87% of cases were in the lower limb, this seems unlikely considering 37.5% of krait bites.[1] Because commonly, krait bites at other sites like in the abdomen, face, neck, back, etc. The authors have not mentioned the area where the SB occurs, whether it was inside the house while sleeping or outdoors while playing. The authors mentioned SB as a common occupational hazard in children in India in the abstract. Though farmers were commonly involved primarily by viper bites and occasionally by cobra bites, while working in cultivational areas or gardens, in the mentioned age groups, it’s unlikely.[1] Instead of mentioning bite time as day and night, providing a time interval would have been more informative.[1] As per our experience, the krait bite is mostly reported between 12 a.m. and 4 a.m. Viper bite most commonly occurs during daytime. Limiting the hospital visit window period to less than or more than 6 hour instead of 12 hour would have been more informative. Since, a delay of more than 6 hour results in respiratory paralysis in krait or cobra bite and bleeding complications, acute renal failure, and compartment syndrome in the case of viper.[3,5]
We hope the points mentioned in this correspondence will be informative to readers.
Author contributions statement (CRedIT Statement)
CRM and AKB: Conceptualization (lead); Methodology (lead); Writing – original draft (lead); Writing – review and editing (equal). RVR and SB: Writing – original draft (Support, equal); Software and investigation (lead, equal); and writing – review, and editing (support); AS: writing – review and editing (support), Visualization, Validation. CRM supervised the whole study, and all authors made a substantial contribution. All authors have read and agreed to the content of the final manuscript. [AKB: Amiya Kumar Barik, CRM: Chitta Ranjan Mohanty, RVR: Rakesh Vadakkethil Radhakrishnan, SB: Srikant Behera, AK: Ashish Kumar]
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
References
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