Snake bites in China: the medical consequences

by Michael Woodhead
Living in Australia, I am naturally extremely wary of snakes, given that this continent has many of the world's most venomous and aggressive varieties - often living in your back yard. Aussies know that if you get bitten by a snake you need to use pressure immobilisation and get help - quick. But what about China? What are the chances of being bitten by a snake and how dangerous are they?
A new report of snake bites from  Hainan gives some idea of what might happen. In a review of more than 1000 cases of snake bites, Dr Shuang Jiebo and colleagues from the 425 PLA Hospital in Sanya, found that the vast majority were caused by pit vipers (46% - aka Trimeresurus stejnegeri) or cobras (40%). Most of the bites occurred in summer (April-Sept) in young males, typically farmers or fishermen, and the bites were mostly on the legs or arms. According to the article the pit viper venom contains a potent haemotoxin, but is not usually fatal:
"The wound usually feels extremely painful, as if it had been branded with a hot iron, and the pain does not subside until about 24 hours after being bitten. Within a few minutes of being bitten, the surrounding flesh dies and turns black, highlighting the puncture wounds. The wound site quickly swells, and the skin and muscle become black due to necrosis."
The Hainan doctors found that most of the wound sites of pit viper bite victims showed swelling, and the skin and muscle became black due to necrosis. In contrast, the cobra venoms are mainly neurotoxic, hemotoxic and cardiotoxic. "The cobra bite is extremely painful and the swelling appears immediately. Other symptoms may include drowsiness, nausea, vomiting, abdominal pain, mental alertness and respiratory failure. "
In their review, about a third of snake bites caused mild envenomation, and only 11% resulted in severe envenomation, which meant a longer hospital stay - often a week or more. Only 1% of patients died, and these tended to be due to bites by sea snakes or King Cobras.
Treatment outcomes were better when patients received prompt treatment - and the researchers also claimed that "Sheyao" traditional medicine was a good remedy for snake bites. This is said to contain  toad skin, centipede, and 'humifuse euphorbia' herb as well as paris polyphylla.
"Prevention, pre-hospital management (first aid) and the importance of the early transfer to the hospital should be emphasized," they concluded. 

Clinical news in brief - from the journals

In 'grassroots' hospitals, knowledge about Parkinson's disease - its diagnosis and management - is very limited for both neurologists and patients, a study from the West China Hospital in Chengdu has shown. Neurologists lacked knowledge of non-motor symptoms, differential diagnosis, therapeutic strategy and appropriate indications of surgical treatment, although they were familiar with the motor symptoms of the disease.

Adenoviruses cause 10% of cases where children are hospitalised for severe diarrhoea in China, according to a study from the Capital Institute of Pediatrics, Beijing.

More than 95% of people in Jiangsu have inadequate levels of riboflavin in their diet, putting them at risk of anaemia, a study has shown.

High levels of arsenic in seafood - and especially shellfish - pose a risk to human health, researchers from Shandong have warned.

People with epilepsy who have been seizure free for at least two years may be able to come off their anti-epilepsy medication, neurologists in Chengdu has shown. In a study of 162 patents with epilepsy who slowly tapered off their medication, 23% had a recurrent seizure and had to re-commence medication.

Ovarian cancer is relatively uncommon in China and rates are in decline, a review by the Henan Cancer Research and Control Office has concluded.

China medical news for Thursday 30 January

Blood lead levels still hazardous for Chinese children
Blood lead levels for children have decreased in recent years but are still at unhealthy levels, a study carried out in 11 cities has found. The blood sampling survey of 12 000 children under six years of age found that average blood lead levels dropped by 16% (from 46μg/L in 2004 to 39μg/L in 2010). The prevalence of elevated blood lead levels dropped by 87% (from 9.8% in 2004 to 1.3% in 2010). Factors associated with high blood levels included eating popcorn, chewing fingernails, sucking fingers, being cared for at home or at a boarding nursery, the study in the World Journal of Pediatrics found.

Rise in China's caesarean rates 'alarming'
The overuse of cesareans is rising alarmingly in China and has become a real public health problem, a review by researchers in Beijing has concluded. The current national caesarean rate is near 40%, and there has been a rapid rise of cesarean sections in recent years, say researchers from the School of Public Health at Peking University. Nonclinical factors such as financial incentives for hospitals were considered as the main drivers fueling the rise of cesareans. However the change in health services to focus on specialised care and marginalizing primary care have also played a role, they say in the International Journal of Women's Health.  

Dengue fever changes in Guangdong
The pattern of dengue fever outbreaks in Guangdong is changing, infectious disease specialists have found. The disease appears to be becoming endemic although outbreaks are caused by the milder types of dengue, researchers report. The prevalance varies between 2-5% and serotypes are now more varied, according to the study in PLOS One.

Puberty arrives earlier for Chinese girls
The age of onset of puberty is now at least a year earlier for Chinese girls compared to those of 1984, a study from the Capital Institute of Pediatrics, Beijing, has found. The research in the World Journal of Pediatrics found that the age of onset of puberty for urban girls had decreased by 4.2 months per decade, and that of rural girls by 9.6 months per decade from 1980 to 2004.

Fish pedicures a hepatitis risk
Aqua pedicures where tiny fish nibble away at dead skin on bathers feet may spread blood diseases such as HIV and hepatitis B, a Ningbo newspaper says. Dr Wang Jiahua, a dermatologist at a local hospital, said there were risks of infection, citing a patient whose legs became hot and swollen days after his first fish pedicure.He suggested a one month interval between fish pedicures and antibiotic ointment to protect skin where wounds are found.

Medications the most comon cause of poisoning in Shanghai

by Michael Woodhead
Overdoses of medications such as sedatives and OTC cough remedies are the most common reasons for people needing treating for acute poisoning in Shanghai hospitals, a study has shown.
A review by forensic scientists of 230 cases of acute poisoning treated at Shanghai hospitals found that the most frequent substances leading to acute poisoning were sedative-hypnotic drugs, antipsychotic drugs, antiepileptics, cough suppressants, analgesics, antidiarrheals, and histamine receptor antagonists. Other common reasons for poisoning were ingestion of pesticides, volatile compounds, and natural toxins. Overall, medications accounted for 48% of female poisonings and 40% of male poisonings.
The researchers aid it was interesting that pesticide ingestion accounted for only 17% of all acute poisonings, which was a figure lower than for less developed parts of China. Also of interest was the very low rate of acute alcohol poisoning, which only accounted for two cases (1% of total poisonings). The researchers said this might be because alcohol poisoning was easily recognised and often self treated.
"In conclusion, the pattern of acute poisonings in Shanghai is similar to that of Japan and some European countries in that acute poisonings are mainly due to medications," the study authors wrote.
"Therefore, the relevant government departments should develop more publicity, education, and management strategies for the rational and safe use of medications. In addition, Shanghai should establish more counseling agencies and websites to address the mental problems of the public that have been brought about by rapid economic development."
Source: Journal of Forensic Sciences