Podcast: view on COVID-19 in West Bengal

India is breaking records of COVID-19 positive cases across the world. Daily cases in the country have hit a new high of over three lakhs. In West Bengal too, one in every three people in West Bengal is testing positive. For the past few days, there have been calls on social media pleading for beds in Kolkata. The election climate though seems apathetic to the pandemic.

In a podcast with Suno India, India’s leading podcast platform, Dr Soumyadeep Bhaumik discusses with Ms Suryatapa Mukherjee talks about :

  • how lack of national #lockdown is killing the poor – no equity
  • need to focus on prevention & think beyond biomedical lens- not just vaccines
  • Need to fix accountability.
  • Learnings which Delhi offers for West Bengal \

Click icon below to listen (opens in new window).


Identifying Research Priorities and Setting Research Agenda in Clinical Toxinology with a Focus on Snake Envenomation

“Identifying Research Priorities and Setting Research Agenda in Clinical Toxinology with a Focus on Snake Envenomation” was the theme of the round table discussion at the Toxinological Society of India Conference 2014 held at Calcutta School of Tropical Medicine on November 22 2014.

Theme lecture on Identifying Research Priorities and Setting Research Agenda was delivered by Dr. Soumyadeep Bhaumik, Cochrane Agenda and Priority Setting Methods Group, & BioMedical Genomics Centre, Kolkata, India

Health Research priority setting processes enable policy-makers, researchers, clinicians and public health professionals to effectively use available resources to collectively decide on what problems or uncertainties are worth trying to resolve/understand for maximal benefit. A transparent and evidence based priority setting process not only helps prioritization but also puts in perspective of patients and the need to improve health outcomes and reverse inequity. Snakebites, a neglected tropical condition, affects millions and kills thousands and yet there is miniscule research in this arena. The presentation focused on the basic concepts of research priority setting exercise, its utility and methods and processes for identifying research gaps and setting research agendas including question formulation, evidence assessment and prioritization process.

The presentation is available here Identifying Research Priorities & Setting Research Agenda. (Click)


The Round Table discussion that followed had the following discussants

1. Professor Y K Gupta (Chair), Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), New Delhi,India
2. Professor Yuri N. Utkin, Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russia
3. Professor Chittaranjan Maity, Head of the Department, Department of Biochemistry,KPC Medical College,Kolkata,India
4. Professor Antony Gomes, Laboratory of Toxinology and Experimental Pharmacodynamics, University of Calcutta, Kolkata,India
5. Professor Juan J Calvete, Laboratorio de Venomica , Estrtuctural y Funcional Instituoto de Biomedicina de Valencia, Spain
6. Dr Soumyadeep Bhaumik, Cochrane Agenda and Priority Setting Methods Group, & BioMedical Genomics Centre, Kolkata, India
7. Professor Santanu K Tripathi (Rapporteur for Toxinological Society of India). Head of the Department , Clinical & Experimental Pharmacology, Calcutta School of Tropical Medicine, Kolkata,India

The discussion focused to understand how priority setting processes can be inculcated in the field of snake envenomation and what broad domains can be considered priorities, as well as the ways to deal with challenges to development and implementation of research agenda in snake envenomation .

Please visit :  http://capsmg.cochrane.org/ for more details and resources on setting research agendas and identifying research priorities.

Snakebite should be a notifiable disease In India : VV Pillay

Dr. V.V.Pillay MD, DCL
Chief, Poison Control Centre
Head, Dept of Analytical Toxicology
Professor, Forensic Medicine & Medical Toxicology
Amrita Institute of Medical Sciences & Research
Cochin, Kerala 682041

The Registrar General of India’s ‘Million Death Study’ has, for the first time, provided a direct estimate of mortality due to snake bite, nationally and in each state. Verbal autopsy was used to identify the causes of all deaths in 6671 randomly chosen sample areas, each covering about 1000 people. In 2005, 46000 people died of snake bite, approximately 1 for every 2 HIV/AIDS deaths. It must be noted that the total number of deaths due to snake bite may be even higher since some victims of nocturnal krait envenoming do not realize that they have been bitten and present with mysterious ‘early morning paralysis’ or seizures. Snake bite accounts for 3% of all deaths in children of the age of 5–14 years. Uttar Pradesh had the highest number of deaths (8700/year) and Andhra Pradesh the highest incidence of mortality due to snake bite (6.2/100 000 population/year).( Natl Med J India 2011; 24(6): 321-324. )

Snake_charmer_in_Sri_LankaNinety seven per cent of the victims of snake bite die in rural areas, 77% of them outside health facilities, presumably because they choose traditional healers. The reason is probably because most bitten people hail from uneducated strata and have more faith in traditional systems of medicine than allopathy. The problem can be addressed by increasing awareness about the dangers of such alternative therapies and the uitility of allopathic remedies, especially anti-snake venom. There are a few Govt-aided programs to tackle this issue, as well as some initiatives by a few NGOs. But they are not enough.
It is important to get snakebite included as a “notifiable disease”, which will make it mandatory for all snakebites to be reported to the public health authorities by doctors and hospitals across India involved in admitting snakebite cases. This will help us get exact figures of incidence of bites and mortality.

Use of snake anti-venom (SAV) in the healthcare system
The Indian Society of Toxicology had come out with a National Snakebite Management Protocol in 2006, based on the proceedings of a national conference in Cochin, Kerala. But the protocol has not received wide publicity or acceptance. As there are no nationally accepted guidelines for the management of snakebite in India, individual doctors and hospitals follow their own regimens. Some doctors claim that they have achieved very good results without employing SAVs, but these claims have not been subjected to peer scrutiny. SAVs are available erratically in the primary healthcare scenario. Sometimes there is adequate supply, and at other times there are no stocks.
SAVs are generally effective in the management of many snakebite cases, but contain antivenoms effective against only the 4 major venomous snakes: Common cobra, Common krait, Russells viper and Saw-scaled viper. Dialysis is often needed in viper envenomations where the patient was taken late to a hospital, or SAV therapy was inadequate or ineffective.
The focus of research in India is on diseases such as hypertension, diabetes, AIDS, etc. As a result, research in the field of snakebite has suffered. A lot needs to be done.

Snakebite neglected, forgotten and victims abandoned: David A Warrell

Prof David A Warrell , Emeritus Professor of Tropical Medicine at University of Oxford and Senior Editor of the Oxford textbook of Medicine and OTM: Infection  in an  interview with Dr. Soumyadeep B discusses various aspects of snakebite. Prof Warrell is a pioneer in research on the incidence, morbidity and mortality of snake bites as well as the clinical presentation, pathophysiology, treatment and prevention of envenoming by snakes and other venomous animals. In the interview he discusses various aspects of snakebite as a public health problem , issues with snake anti-venom and why more research is needed in this field .  

 Dr. Soumyadeep B: There is controversy over the incidence of snake bite and more so its mortality and morbidity. What your opinion on this issue?  How important is snake bite as a clinical condition in India? In terms of public health how important is it? 

Prof. Warrell : There is controversy because, until recently, there were no reliable data. Hospital returns to the Government of India in 2011 reported only 1440 snake-bites, while a much quoted WHO-sponsored study estimated between 11,000 and 15,000 deaths per year by extrapolating from hospital data. Because most snake-bite victims die outside hospital, and even hospital reporting is imperfect, these figures are bound to be underestimates. However, the Registrar General of India’s “Million Death Study” (MDS) has, for the first time, provided nationwide community-based data using “verbal autopsy” to identify snake-bite deaths (a structured interview of the relatives or close associates of the deceased by non-medical staff with central medical coding by at least two doctors). This technique is reliable for snake-bite because the event is distinctive, dramatic and therefore memorable. The result was that, in 2005, 46 000 people (99% CI 41 000–51 000) died of snake-bite in India, approximately 1 for every 2 HIV/AIDS deaths. Assuming that there are 100 non-fatal bites for each fatal bite (from results of a community-based study in Bangladesh) there could be as many as 4.6 million snake-bites in India each year. The MDS results indicate which states of India are worst affected:  the highest numbers of deaths were in Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500). This is clearly a disease of major public health importance, affecting rural people predominantly (agricultural workers and their families including young children). Its clinical importance will become more obvious as villagers are educated to seek medical rather than traditional, ayurvedic treatment.

Dr. Soumyadeep B: Most snake bite victims in India go to traditional or faith healers instead of coming to doctors .Why is it so? How can this cultural aspect be suitably modified? Any notable programs being taken by govt/NGOs/corporates (in India or abroad) towards this direction that you are aware of? What steps do you recommend as an expert?

Photo by Ayyappan Ram on Pexels.com

Prof Warrell  : Rural people trust herbal and other traditional forms of treatment because that is what they are brought up to believe. Traditional practitioners are readily available in the village, their services are cheap and since the overall case-fatality of snake-bites is low (~1% see above) and only about 50% of bites by venomous snakes result in envenoming (injection of sufficient venom to cause local and/or systemic effects) even useless remedies will appear effective in a proportion of cases. However, these treatments have no scientifically demonstrable effectiveness, may be harmful and will delay the patients’ arrival in hospital. Alternative therapies should therefore be discouraged or the traditional practitioners educated to refer patients with definite symptoms of envenoming. Community education is the key to reducing the risk of snake-bite. There are several successful pilot projects, for example in West Bengal and Kerala. The main elements of the programmes are to emphasise where and when the risk of snake-bite is greatest (types of terrain, times of day and times of year) and to encourage safer working and walking by using adequate footwear and other protective clothing and carrying a light after dark; and safer sleeping by using a well tucked-in mosquito net. Victims of bites are encouraged to travel to hospital without delay, not wasting time with traditional treatments. The Australia-based charity “Global Snakebite Initiative” (GSI) http://www.snakebiteinitiative.org/ is committed to promoting preventive programmes for which it is actively seeking funding.

Dr. Soumyadeep B: Research in snakebite epidemiology, prevention, treatment and rehabilitation is important but neglected. Why do you think is reason behind this?

Continue reading “Snakebite neglected, forgotten and victims abandoned: David A Warrell”