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Snakebite envenoming is a well-known medical emergency in the Terai of Nepal in particular. However, there is an epidemiological knowledge gap. The news media data available online provide substantial information on envenomings. Assessing this information can be a pristine approach for understanding snakebite epidemiology and conducting knowledge-based interventions. We firstly analyzed news media-reported quantitative information on conditions under which bites occur, treatment-seeking behavior of victims, and outcomes of snakebite envenomings in Nepal. We analyzed 308 Nepalese snakebite envenomed cases reported in 199 news media articles published between 2010 and 2022 using descriptive statistics, Wilcoxon, and Chi-square tests to know why and how victims were bitten, their treatment-seeking behavior, and the outcomes. These envenomated cases known with substantial information represented 48 districts (mostly located in the Terai region) of Nepal. These envenomings mostly occurred in residential areas affecting children. Generally, envenomings among males and females were not significantly different. But, in residential areas, females were more envenomed than males. Further, victims' extremities were often exposed to venomous snakebites while their active status and these episodes often occurred at night while victims were passive during snakebites indoors and immediate surroundings of houses. Snakebite deaths were less among referred than non-referred cases, males than females, and while active than passive conditions of victims. The most of reported envenomed patients were children, and most envenomings were due to cobra bites. Consultation with traditional healers complicated snakebite management. In most cases, deaths that occur without medical interventions are a severe snakebite consequence in Nepal. Further, several deaths in urban areas and mountains and higher hills of Nepal suggest immediate need of snakebite management interventions in the most affected districts. Therefore, there is an urgent need to immediately admit Nepalese snakebite victims to nearby snakebite treatment centers without adopting non-recommended prehospital interventions. The strategies for preventing snakebite and controlling venom effects should also include hilly and mountain districts where snakebite-associated deaths are reported.

Published information on snakebite is rare in Bhutan although remarkably higher number of snakebites and associated deaths are reported from other South Asian countries. Structured questionnaire was used to collect knowledge of health workers in snakebite management and health seeking behavior of snakebite victims as observed by health workers. Study was conducted in purposively sampled 10 Dzongkhags (district level administrative units) with higher incidence of snakebites. Heath workers scored 27-91% (with an average of 63%, SD = 14) for 52 questions related to snake identification and snakebite management. Among 118 health workers interviewed, 23% had adequate knowledge on snakes and snakebite management while 77% had inadequate knowledge. Among 32 Doctors, 63% of them scored above or equal to 75%. Health workers from Sarpang scored higher (76%, SD = 11) than those from other Dzongkhags. Snakebite victim's visit to local (traditional) healers prior to seeking medical help from hospital was observed by 75 (63%) health workers. Fifty one percent of health workers observed patients treated with local methods such as the use of black stone called Jhhar Mauro (believed to absorb snake venom), application of honey, rubbing of green herbal paste made up of Khenpa Shing (Artemisia myriantha Wallich ex Besser var. paleocephala [Pamp] Ling) and consumption of fluid made up of Neem leaf (Azadirachta indica Juss). Use of tight tourniquet as a first aid to snakebite was observed by 80% of the health workers. Health workers lack confidence in snakebite management. Snakebite victims are likely to suffer from harmful local practices and traditional beliefs on local treatment practices. Empowering health workers with adequate knowledge on snakebite management and making locals aware in pre-hospital care of snakebites are needed to improve the pre- and in-hospital management of snakebite in Bhutan.

Snakebite is an important medical emergency in rural Nepal. Correct identification of the biting species is crucial for clinicians to choose appropriate treatment and anticipate complications. This is particularly important for neurotoxic envenoming which, depending on the snake species involved, may not respond to available antivenoms. Adequate species identification tools are lacking. This study used a combination of morphological and molecular approaches (PCR-aided DNA sequencing from swabs of bite sites) to determine the contribution of venomous and non-venomous species to the snakebite burden in southern Nepal. Out of 749 patients admitted with a history of snakebite to one of three study centres, the biting species could be identified in 194 (25.9%). Out of these, 87 had been bitten by a venomous snake, most commonly the Indian spectacled cobra (Naja naja; n = 42) and the common krait (Bungarus caeruleus; n = 22). When both morphological identification and PCR/sequencing results were available, a 100% agreement was noted. The probability of a positive PCR result was significantly lower among patients who had used inadequate \"first aid\" measures (e.g. tourniquets or local application of remedies). This study is the first to report the use of forensic genetics methods for snake species identification in a prospective clinical study. If high diagnostic accuracy is confirmed in larger cohorts, this method will be a very useful reference diagnostic tool for epidemiological investigations and clinical studies.

Locally prepared liquor, which is not standardized or regulated, though cheap can contain various toxic ingredients and even may be fatal. We report a case series of four adult males who died within 18.5 h due to the effect of local liquor consumption in a hilly district of Gandaki Province of Nepal. Methanol toxicity due to illicitly produced alcohol consumption should be managed with adequate supportive care and administration of specific antidotes such as ethanol or fomepizole. Liquor production should be standardized, and quality checks should be done before the sale for consumption.

Common Kraits, Bungarus caeruleus, cause thousands of fatalities annually in Asia. Here, we aimed to examine stomach contents of preserved kraits to determine their most favored prey animals that might attract them to residences where they bite sleeping people, even under mosquito nets. We examined freshly killed B. caeruleus and those preserved in collections maintained in hospitals and museums during July 2016 to October 2018 to identify contents of their stomachs and intestines. Among 61 examined B. caeruleus, three kraits consumed frogs, three consumed snakes, one consumed a bird, and five consumed rodents. This is the first comprehensive study of the food spectrum of B. caeruleus for Nepal and the third study worldwide. Unlike previous findings, we found the snakes mainly feeding on nonsnake prey animals. Most snakes having empty stomachs and a few specimens with freshly eaten prey animals indicated their entry into dwellings in search of prey animals was because of food stimuli. Findings of partly digested rodents, frogs, snakes, and avian prey (which are commonly found in houses in the lowlands of Nepal) further support food stimuli to be an important factor driving B. caeruleus to residential areas, where they often cause envenomation (69% of total specimens involved in snakebite, n = 42). Our findings can be extrapolated to understand the feeding ecology of B. caeruleus distributed in residential areas and to formulate effective prevention strategies against their bites. Implementing effective and practicable prevention strategies lessens the fear of snakes. This consequently minimizes unnecessary killing of snakes, which in turn contributes to biodiversity conservation.

Snakes play pivotal roles in many ecosystems. While some species, including medically important ones, are considered threatened by the IUCN, snakebite takes a heavy toll on rural agricultural populations in the developing world. Approximately 138,000 deaths and 400,000 disabilities result from snakebite annually and WHO has pledged to reduce the resulting health burden by 50% by 2030. Among a plethora of reasons for insufficient snakebite mitigation, one is limited explicit knowledge of how, where, and when humans and snakes interact, which limits the timely, accurate, and efficient deployment of resources. Here, we revise the list of medically important snakes based on recent taxonomic updates and use high-resolution data from a broad range of published and unpublished resources to compare expert-derived ranges with statistical geographical models of habitat suitability for all 508 most medically important snake species globally. Our study is the first to model every single medically important snake species including data deficient ones, at the highest resolution to date, and with the largest supporting occurrence dataset. We generate geographically explicit estimates of how much human and snake populations overlap (snake-human-overlap-index; SHOI), which is the most fundamental prerequisite for human-snake conflict to occur. Finally, we model the effects of climate change on snake distributions. We predict substantial, short- and long-term shifts in snake distributions, including range contractions for many threatened species and increased human exposure to species of major public health concern. In combination with other drivers of increased snake-human conflict, such as human behaviours and snake traits, our predictions can be used to decide where to stockpile which antivenom, how to ensure adequate capacity of individual health facilities, how to improve health care accessibility of remote at-risk communities, and where to focus conservation efforts for threatened snake species. Hence, we highlight the need for geographically targeted efforts to benefit both vulnerable human and snake populations, as part of a One-Health strategy.

Nepal has one of the highest snakebite fatality rates in south Asia. A study in the country in 2001 indicated an annual incidence, in the study area, of 162 snakebite-related deaths per 100 000 population. If the numbers of out-of-hospital deaths caused by snakebite are to be reduced in Nepal, there needs to be improvements in the public awareness of the benefits of snakebite treatment in hospital and in the pre-hospital care of snakebite - as seen, for example, in Sri Lanka. The corresponding in-hospital mortality will only be reduced by increasing the availability of safe and effective antivenoms and improving critical care for people bitten by snakes. Until Nepal is able to produce antivenom of high quality, antivenoms will need to be imported from other Asian countries or elsewhere. As a temporary measure, i.e. until local production is ready in terms of capacity and funding, antivenoms produced by competent non-profit institutions, e.g. in Brazil or Costa Rica, could be imported.

Indian population, comprising of more than a billion people, consists of 4693 communities with several thousands of endogamous groups, 325 functioning languages and 25 scripts. To address the questions related to ethnic diversity, migrations, founder populations, predisposition to complex disorders or pharmacogenomics, one needs to understand the diversity and relatedness at the genetic level in such a diverse population. In this backdrop, six constituent laboratories of the Council of Scientific and Industrial Research (CSIR), with funding from the Government of India, initiated a network program on predictive medicine using repeats and single nucleotide polymorphisms. The Indian Genome Variation (IGV) consortium aims to provide data on validated SNPs and repeats, both novel and reported, along with gene duplications, in over a thousand genes, in 15,000 individuals drawn from Indian subpopulations. These genes have been selected on the basis of their relevance as functional and positional candidates in many common diseases including genes relevant to pharmacogenomics. This is the first large-scale comprehensive study of the structure of the Indian population with wide-reaching implications. A comprehensive platform for Indian Genome Variation (IGV) data management, analysis and creation of IGVdb portal has also been developed. The samples are being collected following ethical guidelines of Indian Council of Medical Research (ICMR) and Department of Biotechnology (DBT), India. This paper reveals the structure of the IGV project highlighting its various aspects like genesis, objectives, strategies for selection of genes, identification of the Indian subpopulations, collection of samples and discovery and validation of genetic markers, data analysis and monitoring as well as the project's data release policy.

Models available in the literature on nutrient uptake, light availability, and chlorophyll growth have been suitably modified and integrated through the computer program CHLORF (written in \"C\" language), which has the advantage of being amenable to simulation under various combinations of input variables. The model has been used for sensitivity analysis in order to identify the most sensitive set of parameters whose control can form an appropriate basis for evolving pragmatic management strategies. In addition, greenhouse mitigation potential has been computed in terms of assimilation of carbon dioxide for a case study of Indian wetlands.