BACKGROUND

Snake envenomation accounts for 91 deaths in the Philippines (Roberts et. al., 2021). The management of snakebite envenomation poses a critical challenge, particularly in settings with limited antivenom supplies. This study determines the symptom severity of snakebite envenomation and treatment outcomes of snakebite patients admitted in Northern Mindanao Medical Center from October 2017 to October 2022, who received lower doses of cobra antivenom with or without Neostigmine.

This was a single center descriptive study that reviewed 82 medical records of admitted snakebite patients at NMMC. Data were analyzed using descriptive statistics.

Admitted snakebite patients came from Bukidnon (42%), Misamis Oriental, Cagayan de Oro City, Lanao del Norte, Lanao del Sur, and Misamis Occidental. Those affected were predominantly 19-59 years old (mean age of 33), mostly male (73%), living in rural areas, and working in agriculture. At least half of the patients (45%) with signs of neurologic envenoming received less than the standard protocol dose of Cobra antivenom. The rest received Neostigmine (1%), both Cobra antivenom and Neostigmine (11%), and neither (43%). Moderate envenomation predominated (46%), followed by mild (43%) and severe (11%) envenomation. Regardless of symptom severity, most patients received 1-2 ampules (28 patients) or 3-5 ampules (14 patients); only four `patients received 6-10 ampules. Moderate and severe envenomation could be managed with reduced antivenom. Patients stayed in the hospital for 3-6 days (55%). The majority were discharged improved (96%). No mortality was noted. Only four patients experienced adverse effects from Cobra antivenom (skin rash and dyspnea) and Neostigmine (skin rash). 

Most cases occurred in the rural province of Bukidnon, primarily affecting males aged 19-59 (mean age 33) working in agriculture. Moderate and severe envenomation were effectively managed, fully reversing envenomation symptoms with reduced antivenom doses (1-5 ampoules), contrary to established guidelines recommending higher doses. The use of Neostigmine as an adjunct therapy appears promising for addressing antivenom supply shortages. Majority were discharged improved and a low incidence of adverse reactions. 

Acquired perforating collagenosis (APC) is a rare dermatological condition characterized by the spontaneous eruption of skin-colored or erythematous papules or nodules that eventually ulcerate and exude collagenous material. The exact etiology of APC remains unclear, although various triggers, including infections, medications, autoimmune diseases, and trauma, have been implicated.

This case report presents a 63-year-old female with a history of diabetes who developed erythematous papules and plaques topped with thick, yellowish, hyperkeratotic, adherent crusts on the upper back following an insect bite. Histopathological examination confirmed the diagnosis of APC, characterized by a cup-shaped invagination in the epidermis containing degenerated collagen bundles and basophilic material. Masson-trichrome staining showed transepidermal elimination of the collagen fibers. Patient was initially prescribed tretinoin 0.1% cream to be applied 2x a day. However, patient was not able to apply prescribed medications. Interestingly, without any specific treatment, the patient’s symptoms gradually improved over 3 months and eventually resolved completely.

This case report highlights the spontaneous resolution of APC in a patient following an insect bite. While most cases of APC require medical intervention, this case demonstrates the potential for spontaneous healing in certain individuals. Further research is needed to understand the factors that influence the course of APC and to identify potential predictors of spontaneous resolution.

Humans ; Herpesvirus 4, Human ; Insect Bites and Stings ; Killer Cells, Natural ; Epstein-Barr Virus Infections ; Neoplasms ; Lymphoproliferative Disorders

Bite marks are increasingly common in violent cases such as child abuse and sex crimes. Bite marks are often the result of a suspect's attack or a victim's self-defense. Because human teeth vary in size, shape and arrangement, bite marks on objects such as skin and food are characteristic. By using this principle, forensic odontology can identify or exclude suspects by comparing actual bite marks with the teeth marks in the mouth. In this paper, the practical application of bite mark evidence, the research status and problems of bite mark analysis are briefly reviewed, and the prospect of bite mark analysis is also discussed.
Bites, Human ; Child ; Child Abuse ; Face ; Forensic Dentistry ; Humans ; Tooth

Replantation using microvascular anastomosis is considered to be the optimal method in treating the amputated ear in terms of resulting color, texture, and shape. Only a few cases of ear replantation have been reported because it is anatomically difficult to identify suitable vessels for anastomosis. We successfully replanted the amputated helical rim of the ear using single arterial anastomosis. A 37-year-old man had his helical rim amputated by a human bite. The amputee was about 4 × 1 cm in dimension, composed of skin and soft tissue including auricular cartilage. Replantation was performed anastomosing a small artery of the amputee with a terminal branch of the posterior auricular artery. After replantation, intravenous heparinization was performed and prostaglandin E1 and aspirin were administered. Venous congestion was decompressed by stab incisions applied with heparin solution soaked gauze. Venous congestion of the amputee slowly began to resolve at 4 days after the operation. The amputated segment of the helical rim survived completely with good aesthetic shape and color. The authors propose that performing microvascular anastomosis should be attempted especially if it is possible to detect vessels on cut surfaces of ear amputee and stump. Proper postoperative care for venous congestion, arterial insufficiency, and infection should be followed for amputee survival.
Adult ; Alprostadil ; Amputation ; Amputees ; Arteries ; Aspirin ; Bites, Human ; Ear ; Ear Cartilage ; Heparin ; Humans ; Hyperemia ; Methods ; Microsurgery ; Postoperative Care ; Replantation* ; Skin

No abstract available.
Bites, Human* ; Ear* ; Humans ; Humans* ; Hyperbaric Oxygenation* ; Transplants*

When hand injuries caused by human bite are overlooked and they can progress to pyogenic arthritis. Pyogenic arthritis is difficult to treat and can make severe sequelae in the joints. We report a case of pyogenic arthritis of the hand that occurred after human bite injury in adolescent treated with wide debridement and external fixator. Our literature searches revealed that the use of external fixator is good treatment option for the treatment of pyogenic arthritis of the hand.
Adolescent* ; Arthritis* ; Bites, Human ; Debridement ; External Fixators ; Hand ; Hand Injuries ; Humans ; Joints ; Metacarpophalangeal Joint*

We reported a 30 years old man who suffered a bite wound of the right hand in a fight. Two days after the injury, he was admitted in emergency because of stab wound above the head of the third metacarpal bone. He presented the swelling, redness, pain and fever. Primary revision confirmed only partial lesion of the extensor apparatus. During the following days, we recorded a deterioration of local findings and magnetic resonance imaging revealed osteomyelitis and septic arthritis of the thirdmetacarpophalangeal joint. The wound was then revised several times using negative pressure wound therapy in combination with intravenous antibiotics. After resolution of clinical and laboratory findings, the wound was finally closed by delayed primary suture. Clenched fist injury is a medical emergency that requires immediate surgical revision. We treated clenched fist injury with the development of septic arthritis and osteomyelitis with negative pressure wound therapy and obtained good outcomes.
Adult ; Arthritis, Infectious ; etiology ; therapy ; Bites, Human ; complications ; Humans ; Male ; Metacarpophalangeal Joint ; injuries ; Metacarpus ; injuries ; Negative-Pressure Wound Therapy ; Osteomyelitis ; etiology ; therapy

Human bite injury to the eyelid is extremely rare and poses a significant challenge in surgical reconstruction. We report an extremely rare case of human bite injury to the eyelid in a 43-year-old male with approximately 60% full thickness loss of the upper eyelid and 80% to 90% full thickness loss of the lower eyelid and its successful reconstruction using the local advancement cheek flap.
Adult ; Bites, Human* ; Cheek ; Eyelids* ; Humans ; Humans* ; Male

Animal bites are a common problem managed by primary physicians and often involve wound infection, neurovascular injury, poor cosmetic outcome, and high medical costs. During clinical assessment, a thorough medical history is acquired, including details of the bite circumstances and the patient's immune status and vaccination history. A meticulous physical examination should be performed in order to identify any injuries to deep structures, in addition to exploring the wound by creating a narrow opening and using diagnostic tools such as radiograph and ultrasound where necessary. Infection is the most problematic complication after a bite injury. Cleaning, irrigation, and debridement are the most important steps in preventing infection. The use of prophylactic antibiotics is controversial, but probably indicated in immunocompromised individuals and in anatomical areas that are more likely to be infected, such as the hand and foot. The decision to close a bite wound must be based on consideration of the benefit of a good cosmetic outcome and the increased risk of infection. In Korea, human rabies has not occurred since 2005, but the transmission of rabies is still a concern with animal bites. The transmission of viral hepatitis, herpes virus and human immunodeficiency virus can occur following human bites. To prevent the transmission of various viruses, healthcare providers should know the guidelines for post-bite exposure prophylaxis.
Animals ; Anti-Bacterial Agents ; Bites and Stings ; Bites, Human ; Debridement ; Foot ; Hand ; Health Personnel ; Hepatitis ; HIV ; Humans ; Immunization ; Korea ; Physical Examination ; Rabies ; Ultrasonography ; Vaccination* ; Wound Infection ; Wounds and Injuries