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All you need to read in the other general journals

BMJ 2008; 337 doi: (Published 11 November 2008) Cite this as: BMJ 2008;337:a2463

Thousands die each year from snake bite—a neglected tropical disease

At least 421 000 people are bitten and poisoned by snakes each year, according to a new study. At least 20 000 of them die. The actual figures could be—and probably are—considerably higher, say the authors. Snake bites are a seriously neglected tropical disease, and reporting is poor, particularly in low and middle income countries where snake bites are most common.

These authors computed their global estimates from published and unpublished literature, a mortality database held by the World Health Organization, and discussions with international experts. Annual numbers of snake bites complicated by poisoning (envenomings) were highest in India (81 000/year), followed by Sri Lanka, Vietnam, Brazil, Mexico, and Nepal. India also recorded the most deaths in 2007 (11 000). The rate of poisoning per head of population was high in sub-Saharan Africa, but the quality of the data was poor.

A more accurate global picture of snake bites and of the deaths and disabilities that follow is needed urgently, says a linked comment (10.1371/journal.pmed.0050221). Antivenom is in short supply and expensive after price hikes in recent decades. Low income countries simply can’t afford it, and people are dying unnecessarily as a result. Better data would help manufacturers and medical authorities distribute this scarce and valuable resource more equitably.

Combined drug treatment for opioid addiction works, while it lasts

The combination of buprenorphine and naloxone may be a useful treatment for young people addicted to opioids, but many relapse when the course finishes. This is the headline finding from a short term trial, comparing two weeks with 12 weeks of treatment in 152 young adults with a mean age of 19.

The participants treated for longer did better at first than controls. But the difference had disappeared by week 12, after nine weeks’ full treatment followed by a three week taper. At this point, 43% (95% CI 29% to 57%) of those …

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