Bell’s Palsy
This condition is a motor unit facial paralysis of unknown etiology. But, it is presumed to be due to edema of the facial nerve as it passes through the facial canal in the temporal bone.
Clinically, the person with Bell’s palsy will have the following:
- pain in the ear of the affected side
- facial paralysis
- the unaffected side pulls the face producing an
asymmetric facial expression - difficulty in closing the eyes, drinking or eating
- if the paralysis is complete, the face sags and excessive
lacrimation or tearing is observed - some will have a subclinical peripheral neuropathy
About 60% of the cases recover completely. The remainder will develop signs of denervation, post paralytic features such as partial paralysis of individual muscles, loss of associated movements and facial contractures.
Generally, the management of Bell’s palsy includes the use of vasodilator agents, vitamin C and steroids. Also, the eyes will be covered with eye patch and application of an eye ointment to prevent corneal drying and secondary infection.
(Editor’s Note: Due to the request of some of our readers, we are publishing again below, the Medical Insider written by Dr. Ria Maslog, June 6, 2021 edition.)
Snakebites
It is a fact that with the 3500 known species of snakes in the world, only 200 are poisonous to humans. All poisonous species are members of four families which are:
1. COLUBRIDAE
2. Elapidae
3. Hydrophidae
4. Viperidae
The Elapidae are among the most deadly species of snakes. Members of this family include the cobras, mambas and coral snakes.
During the virtual inter-hospital conference last Wednesday, June 2, 2021, Dr. Diannah J. Georlin, a pediatric resident of Gov. Celestino Gallares Memorial Hospital, presented a case series on snakebites. She mentioned the difference between venomous and non-venomous snakes.
A poisonous snake has the following features:
> a triangular head (arrowhead)
> elliptical pupil
> with fangs
> single row subcaudal plates
A harmless snake has the following characteristics:
> oval head ( egg-shaped)
> round pupil
> with snout
> with teeth
> double row subcaudal plates
From the conference, I learned that snakes bite humans when the latter would move into their favored habitat and as a defense when trodden upon by people walking in the dark. But snakes make a sound to alert someone that they are there and/or show their head to be recognized. The peaks of snake bites are during seasonal rains and increase in agricultural activity.
Nelson Textbook of Pediatrics stated that approximately, 20% of all poisonous snakebites result in no envenomation. Furthermore, the severity of the envenomation depends on many variables
1. Related to the victim : age of the victim, general health, size of the victim.
2.related to the snake: species, condition of the venom glands and fangs
3. Related to the bite: number, location, depth, amount of venom injected
4. Related to the promptness and effectiveness of initial therapy: Clinically, victims may complain of burning pain and swelling at the site within minutes from the bite. And as the venom spreads to the body through the lymphatics, there is advancing edema and ecchymosis of the involved site. Some will have nausea, vomiting, diaphoresis, numbness or tingling sensations around the mouth, scalp and digits. If treatment is not given immediately, there is generalized edema, shock, and cardiac arrythmias and death ensues.
It is noteworthy to mention that there is a snake bite severity score that helps physician classify and manage patients accordingly. Dr Georlin clearly explained the stages of the management of snake bites:
1. First aid treatment: reassure the victim; attempt to delay systemic absorption of venom; arrange the transport of the patient to a place where they can receive medical care
2. Transport to hospital: must be done quickly, safely and comfortably; reduce movement of the bitten limb to absolute minimum; recovery position
3. Rapid clinical assessment and resuscitation:
4. Detailed clinical assessment and species diagnosis
5. Investigations/ laboratory tests
6. Anti-venom treatment
7. Observing the response to anti-venom
8. Deciding whether another dose of anti-venom is needed
9. Supportive treatment
10. Treatment of the bitten part
11. Rehabilitation
12. Advice
To prevent snake bites, the following are suggested:
1. We should keep our homes and surroundings clean
2. Keep livestock indoors
3. Discourage rodents in the area
4. Always use a light or stick when walking outside at night
5. Use solid shoes or boots in the agricultural fields
6. Community education and raising awareness about prevention of snake bites is the most effective strategy for reducing morbidity and mortality
Furthermore, we should remember these 4 useful initial questions to the victims:
1. In what part of your body were you bitten?
2. When were you bitten and what were you doing when you were bitten?
3. How did the snake that bit you look like?
4. How are you feeling now?
To end this article, may I say that one of our veterinarians here in the city said and i quote, “Snakes are not our enemies, we should learn to recognize them,” and that, “Keep dogs and cats at home to protect yourself and your family against snake coming to your place.”