How Likely You Are To Die From A Wild Animal Attack
Chin J Traumatol. 2021 November; 24(half-dozen): 383–388.
Pattern of injuries due to wild animal assail amongst patients presenting to the emergency department: A retrospective observational study
Pradeep Kumar Singh
aDepartment of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
S Manwar Ali
aDepartment of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, 751019, India
Rakesh Vadakkethil Radhakrishnan
bCollege of Nursing, All Bharat Institute of Medical Sciences, Bhubaneswar, 751019, India
Chitta Ranjan Mohanty
cSection of Trauma and Emergency, All India Constitute of Medical Sciences, Bhubaneswar, 751019, India
Manas Ranjan Sahu
dDepartment of Forensic Medicine and Toxicology, All India Establish of Medical Sciences, Bhubaneswar, 751019, Republic of india
Bishnu Prasad Patro
eDepartment of Orthopedics, All India Plant of Medical Sciences, Bhubaneswar, 751019, India
Ijas MS
cSection of Trauma and Emergency, All Republic of india Constitute of Medical Sciences, Bhubaneswar, 751019, Bharat
Susant Kumar Panda
fDepartment of General Surgery, District Head Quarter Infirmary, Angul, Odisha, 759122, India
Received 2021 May 16; Revised 2021 Jul 26; Accepted 2021 Aug 30.
Abstruse
Purpose
The human-wild animals conflicts (HWCs) causing nuisances and injuries are becoming a growing public health concern over contempo years worldwide. We aimed to study the demographic profile, mode of injury, blueprint of injury, and outcome of wild animal attack victims presented to the emergency section.
Methods
This retrospective cantankerous-sectional study was conducted in the emergency department of a tertiary-intendance hospital in Eastern India. Data were retrieved from the medical records from May 2017 to May 2021. Patients of all ages and genders attacked by wild animals and secondary injuries were included in this written report. Patients with incomplete information, injuries due to the attack of stray and domestic animals and trauma due to other causes were excluded. Demographic profile, mode of injury, the design of injury, injury severity score (ISS), radiological pattern, and outcome were recorded. Statistical analysis with R (version iii.6.1.) was conducted.
Results
A total of 411 wild animal set on victims were studied, of which 374 (90.9%) were snakebite injuries and 37 (nine.one%) were wild mammalian (WM) assault injuries. The mean age of WM assault victims was 46 years, and the male-to-female ratio was 4:1. Elephant attack injury (40.five%) was the most common WM attack injury reported. Virtually WM attacks (43.2%) occurred between four:00 a.chiliad. to 8:00 a.m. The median ISS was 18.5 (13–28), where 54.ii% of patients had polytrauma (ISS>15). Elephant attack was associated with a higher ISS, but the difference was non significant compared to other animate being types (p = 0.ii). Blunt trauma was mutual design of injury in the elephant attack injury cases. Lacerations and soft tissue injuries were mutual patterns in other animal attacks. Amid snakebites, neurotoxic was the most common blazon (55.4%), and lower extremity was the most common site involved.
Conclusion
The young male population is the major victim of HWCs; and elephant is the nigh common animal involved. There is a need to design scientifically sound preventive strategies for HWCs and to strengthen the preparedness in health establishments to manage victims effectively.
Keywords: Wild animal, Injury severity score, Elephant, Wild boar, Polytrauma
Introduction
The homo-wild animals conflicts (HWCs) causing nuisances and injuries are growing public health concerns over recent years worldwide, especially in the southeast Asian region.1,2 The steadily rising trend in wild animal inflicted injuries substantially contributes to society's overall burden. Notably, the nuisance and injuries amongst people oft give ascension to hostility and anger confronting the involved wild animals, putting challenges for wild fauna conservation.3 Despite their rarity, wild animal injuries often assume severe forms, resulting in high mortality and morbidity.4 Deforestation, urbanization, industrialization, migration, and human being intrusion to wild life are some of the prevailing states of affairs that render wild animals losing their natural habitats and increasing their presence over the indwelling human areas.5 Earlier literature from India had reported injuries resulting from HWCs with elephants, deport maul, tigers, leopards, hyena, wild boar, and monkeys from some regions, especially from the northern, central, and eastern states.6, 7, 8 Odisha is a tribal-dominated state located on the east coast of Republic of india. It has a thick coverage of forest expanse constituting 37.34% of total state area with diverse flora and beast.ix This makes the inhabitants of this aera more susceptible to injury past wildlife. The victims of wildlife attacks nowadays with varying injury patterns ranging from simple soft tissue injuries to grievous organ injuries and even death.
Hence, the current study aimed at describing the design of injuries, style of injury, and effect among victims of wild animal attacks presenting to the emergency department (ED).
Methods
This retrospective observational study was performed in the ED of a third care hospital in eastern India. The approval was obtained from the found ideals research commission (IEC Ref No: T/IM-NF/Gen.Surg/20/122). The article adheres to the Strengthening the Reporting of Observational Studies in Epidemiology Statement: guidelines for reporting observational studies. All cases of wild animal attacks attending the ED of our institute from May 1, 2017 to May 1, 2021 were included in the report. The inclusion criteria were victims of wild animal attacks regardless of age and gender. The exclusion criteria were (1) incomplete data; (2) injuries due to the attack of stray and domestic animals; and (3) other causes of trauma.
The paper-based records of patients were retrieved from the medical record section, and the data were compiled on a pre-designed structured pro-format and Microsoft Excel worksheet. Data pertaining to the basic demographic details (age and sex), time and place of the animate being attack, type of animals, and details of patient occupation were recorded. The machinery of injury was categorized as direct or indirect. The anatomical site of injury was classified and described every bit caput injury, maxillofacial injury, chest injury, abdominal injury, extremity injury, and soft tissue injury. The pattern of injury was categorized as blunt trauma injury, lacerations, or soft tissue injuries. The severity of the injury of wild mammalians (WM) attacks was calculated using the injury severity score (ISS). The standard assessment and resuscitation protocol for trauma patients was employed to all animal attack victims. All patients having WM bites were treated with anti-rabies vaccination and anti-tetanus injection, while with anti-tetanus injection alone in instance of snakebite. The routine investigations like complete blood count, liver function exam, renal office test, serum electrolytes, coagulation profile (prothrombin time, activated partial thromboplastin time, international normalized ratio), and clot retraction test were washed in all snakebite cases. The emergency procedures perfomed in the ED were recorded. The patient management approach was categorized every bit conservative or surgical. The outcome was recorded equally admitted, discharged, or referred.
Statistical assay was done past R version 3.6.i. Chiselled variables were expressed every bit frequency and pct. The Shapiro-Wilk exam determined the normalcy of numerical data. Numerical parametric variables were expressed as hateful ± standard deviation and non-parametric median with interquartile range (IQR). Kruskal-Wallis test was used to compare the ISS between different groups of animals. A value of p < 0.05 was regarded as statistically significant.
Results
The menstruum diagram of the written report is shown in Fig. 1. A total of 37 WM attack victims and 374 snakebite cases were included for analysis. Snakebite (90.9%) was the most reported wild animal set on. Among WM attacks, elephant assail (40.five%) was the most commonly reported. The year-wise cases of wild animal set on are shown in Table 1. Amidst the snakebite victims, the majority had neurotoxic envenomation (55.4%), with lower extremities being the most common bitten site (72.9%). The mean age of WM set on victims was (46 ± 15.2) years, and the male person-to-female ratio was 4:one. The mean historic period of snakebite victims was (36 ± 14.3) years, and the male person to female ratio of snakebite cases was 3:1. Approximately, 43.3% of snakebite cases occurred in residential areas. Amongst the location of WM attacks, virtually attacks (forty.4%) occurred in rural residential areas, followed by urban residential areas (35.2%), where 25.five% occurred in farmland and forest. The major mode of injury was a directly attack past the WMs. Indirect mode of injury (route traffic accidents and fall from height) deemed for 66.half dozen%, 43.2%, and 12.eight% in the case of monkeys, wild boar, and elephant, respectively. All attacks by wildlife were unprovoked, except 1 provoked attack by a monkey and another past a bear. The early morning time (4:00 a.k. to eight:00 a.m.) was the most common fourth dimension of assail by wild animals (43.ii% of cases), and details of injury times are depicted in Fig. 2A. The most mutual time of snakebite (43%) was 12:00 p.m. to iv:00 p.one thousand. The pattern of injuries due to WM attacks and the radiological findings are detailed in Table 2. Fig. iii (A to East) shows the injuries due to unlike types of wild creature attacks. The radiological findings in elephant attacks are shown in Fig. 4. Lacerated wounds and soft tissue injuries were commonly reported in the bear, wild boar, and monkey attacks.
Flow diagram of the study.
Table 1
Year wise cases of wild mammalian attacks and ophidian bites (n).
| Year | Elephant attack | Wild boar assail | Monkey assail | Bear attack | Snake bite | Total |
|---|---|---|---|---|---|---|
| 2017 | 1 | 3 | 0 | 0 | 75 | 78 |
| 2018 | ane | 1 | 2 | ii | 121 | 127 |
| 2019 | 1 | 0 | 4 | 0 | 144 | 159 |
| 2020 | 6 | three | 1 | 1 | 101 | 112 |
| 2021(till May) | 6 | three | ii | 0 | 34 | 45 |
(A) Bar plot showing distribution of fourth dimension of wild brute assail; (B) Boxplot showing comparison of injury severity score betwixt different types of fauna assail victims.
Tabular array 2
The pattern of injuries due to wild brute attacks and the radiological findings. (n = 37).
| Brute type | Injury pattern | Radiological findings | ||
|---|---|---|---|---|
| FAST | Ten-ray | CT scan | ||
| Elephant (n = 15) | Head injury (n = iv) Blunt trauma chest (due north = 11) Edgeless trauma abdomen (north = 8) Penetrating breast injurya (due north = 1) Extremity injuries (northward = 10) | Positive (n = 4) | B/L haemothorax with rib fracture (n = 2) | Head CT: intra-ventricular haemorrhage with pneumocephalus (n = one) Head CT: WNL (n = 3) Chest CT: B/50 haemothorax with ribb (n = 2) Right haemothorax (northward = 2) Right pneumothorax (n = two) T12 spine compressionb (n = 1) |
| Monkey (n = 9) | Head, maxillofacial and extremity injuriesa (n = 5) Distal tibia and lumbar spine fracturea (n = 2) Abrasions, lacerations, and soft tissue injurya (n = two) | Negativea (n = 6) | Fracture distal tibiaa (northward = 1) Fracture distal tibia and talusa (due north = 1) | 3D face up reconstruction: correct mandible, condyle, and para symphysisa b (n = i) Displacedb of dento-alveolar complex (n = i) L1 spine bodya b (n = 1) L2-L3 spine compressiona b (northward = one) |
| Wild boar (due north = x) | Laceration of upper extremity (n = 3) Laceration of lower extremity (n = 4) Soft tissues injuries (n = four) Head and maxillofacial injuriesa (n = 2) Extremity injuriesa (due north = two) | NA | Left distal radiusa b (n = 1) Fifth metatarsala b (n = 1) | 3D confront reconstruction: nasal osa b (due north = ane) |
| Behave (n = three) | Caput injury (north = ane) Maxillofacial injuries (n = 2) Soft tissue injuries (n = ii) Laceration of upper and lower extremity (due north = 3) | NA | Chemical compound fracture of tibia (n = 1) | 3D face reconstruction: zygomatic boneb (n = 1) |
Injuries due to creature attack. (A) Victim of elephant set on (laceration of forearm); (B) Victim of bear attack (laceration of trapezius region); (C) Victim of wild boar attack (maxilla-facial injury); (D) Victim of monkey attack (injury of scalp due to RTA); (E) Victim of elephant attack (wound after debridement); (F) Victim of vasculo-toxic snake bite (swelling of lower extremity).
Radiological findings in elephant assault: (A) 3D reconstruction of CT chest showing 1st and 2nd rib-fracture; (B) Cantankerous-sectional epitome of CT thorax showing haemothorax.
The median ISS among the victims was 18.5 (thirteen–28), where 54.two% had polytrauma (ISS>15). A higher ISS was observed in victims of elephant attacks in comparison to others, but the comparing between all animal types was non pregnant (p = 0.two). The ISS across various wild brute inflicted injuries is depicted in the boxplot (Fig. iiB). In the ED, 19 patients (51.3%) received wound suturing and dressing, eleven patients (29.7%) required splint or bandage application. Chiliad-wire fixation was washed in ii patients in the ED. The chest tube insertion was required in 6 (16%) patients, out of which 2 patients had bilateral chest tube insertion. Of the full WM set on patients, 16 (43.2%) were discharged after primary treatment from the ED; 6 patients (xvi.two%) were admitted to intensive intendance unit (ICU); xiv patients (37.8%) were admitted to the ward, out of which 7 patients underwent orthopedic surgical procedures; ii patients underwent neurosurgical procedures; and i (2.seven%) patient was referred. I patient post-obit an elephant attack died during treatment in ICU. Totally 359 (95.9%) snake bite patients received anti-snake venom medication in the ED. Two-hundred and thirty-v (62.viii%) patients were discharged after treatment in the ED, 128 (31.1%) were admitted in the ward, and 11 (3.two%) admitted in ICU.
Discussion
In the ED, wild beast attack injuries presented as soft tissue injury, lacerations of unlike trunk parts, and edgeless trauma to the head, chest, belly, and extremities, similar to injuries due to route traffic accidents and physical assault. The indirect injuries due to wild animal assail that resulted in road traffic accidents or autumn from height is also similar to conventional injuries. The wildlife can inflict serious tissue injury with their powerful jaws and grinding teeth.10 Unlike conventional wounds due to other causes of trauma, the run a risk of wound infection is significant, and systemic illnesses, such as brucellosis, leptospirosis, or tularemia, tin can follow the injury.x
The present written report described the socio-demographic profile of victims of wild animate being attacks, their manner, and pattern of injury. The young, active male population were the major victims of wild animal attacks, and near reported were snakebites and elephant attacks. The victims suffered by and large edgeless trauma in instance of an elephant and deport set on. Soft tissue injuries and lacerations were the predominant injury pattern in the acquit, wild boar, and monkey attacks. The incidence of HWCs is taking a steady tendency over recent years globally, specially in the southeast Asian region. Eastern India is geographically and topographically dissimilar from the residue of the nation, with dense forest coverage accommodating a rich diversity of flora and creature.9 Existence a tribal-dominated land, Odisha marks the presence of human indwelling areas near this big clamper of wildlife, making inhabitants of this function of the state most susceptible to attacks from this wildlife.
In the present written report, snakebites accounted for most of the wild animal attacks (90%), with neurotoxic bites outnumbered vasculotoxic bites (55% vs. 45%). The findings are in contrast with earlier studies from India that reported Russel's viper is the almost common serpent species in the country known to produce vasculotoxic envenomation.11,12 However, i previous study from India past Vora et al.13 also reported more of neurotoxic envenomation in their series of snakebite victims. The eastern India region is notorious for harboring sizable share of elapid snake species like Indian cobra, and commonly krait produces neurotoxic envenomation. Furthermore, the bulk of the bites occurred in the lower extremities (73%), with peak incidents during the rainy seasons (June to September), which agrees with findings of Bhuiyan et al.14 and Suraweera et al.12
In our study, males were the predominant victims (eighty%) of WM attacks, which agrees with the findings of other studies.7,8,15,sixteen It is considering males are more involved in outdoor activity than females. The hateful age of patients was 46 years, which is similar to earlier literature that highlighted a college incidence of brute attack injuries in the third decade of life.seven,15 Nearly of our patients (40%) were from rural areas, which agrees with the report past Gilyoma et al.,15 in which most patients belong to rural areas. Conversely, Bombieri et al.xvi reported the prevalence of wild animal attacks on humans in urban dwellers in their study based in the North American region. In our study, the majority (44%) of the patients sustained WM attacks during early forenoon hours, and near of the attacks are unprovoked. The findings are in line with reports of Bhat et al.,7 the wild animals invade farmlands and nearby village areas to consume crops and drinking water from ponds during night or forenoon time and may see people who were on their way to piece of work during these morning hours. In the current study, near (40%) of the WM attack occurred in rural residential areas and 35% got attacked in urban residential areas. But 25% occurred in farmland or woods areas, signifying wider intrusion of wild fauna into the human being indwelling areas. This contrasts with earlier studies reported from other locations of our country, which reported most attacks occurred in wood and adjacent farmlands than residential areas.seven,8 Our centre is in the capital city of Odisha state, having proximity to the nearby dense woods areas, and likely to go patients who suffered injuries from nearby localities. At that place were many reports of wild animal attacks in Odisha'southward rural and urban residential areas during contempo times.17, eighteen, 19, xx Furthermore, the study eye is a tertiary care facility and received referral cases from rural, semi-urban, or urban localities. Most of those patients with pocket-sized injuries that had occurred in forests or farmlands would have received treatment from nearby local health facilities. Earlier studies also highlighted that nigh animals inflicted injuries event in balmy trauma and can be managed with ambulatory treatment without requiring further hospitalization.10,15
Most elephant attacks were reported in the early morning hours as people went for their morning work. The victims of elephant attacks had a higher ISS of 32 compared to other WMs in our study, suggesting fatal injuries.21 The findings agree with Acharya et al.,2 who reported attacks by elephants had a higher odd of being killed in comparison to leopard, tiger, and rhino in a study conducted in our neighbouring country of Nepal. The pattern of injury inflicted by elephants to humans is quite dissimilar due to the disparity in their sizes. They usually utilise blunt force to assault, while penetrating injuries past tusk is uncommon. Edgeless chest and abdomen trauma were the near mutual reported design of injury, though head and maxilla-facial injury also reported which is like to other studies.2,22 Nearly half of our patients suffered an attack by elephants. The menace of wild elephants is taking an alarming toll in the country, where a recent study revealing virtually 680 peoples were killed past elephants set on alone over the last 8 years.23 Considering the rise trend of wild animate being attack in the state, the government initiated several efforts to safeguard both human and wildlife but are suboptimal to cater the actual need. The state government launched monetary bounty for victims of wild fauna attacks decades agone and has been periodically revised over the years, especially for fatal attacks, which is currently running at a sum of 6800 USD. To rescue the elephants in distress, the woods department is besides equipped with special vehicles to drain them back to their natural habitats.23
Monkey-related injuries were mostly indirect in our study, every bit the victims suffered from route traffic accidents or fall from height afterwards the attack by the monkeys. Those sustained direct injuries were soft tissue injuries. The monkey-inflicted injuries are likewise on the rising in the land over recent periods.18,24, 25, 26 The wild boars are constitute-eating herbivorous animals which accounts for injuries in 27% of WM attack victims. Wild boar attack injuries mostly took place in villages where they enter for nutrient and attack the locals or the farmers while working in the paddy field. They mostly entered the ingather field during the dark hours to eat crop. Well-nigh victims suffer laceration of the lower and upper extremities. Increased incidence of wild boar attacks also being reported from urban areas in recent times, where they typically attack multiple victims at a time and mostly post-obit cluster attacks.17,19 Bear is the most common wild animal involved in HWCs in Bharat,7,8,27 though it is opposite to the results of our study. The victims normally sustain tearing, burdensome, or penetrating injuries as the fauna attack with powerful paws, claws, and teeth. The extremity injuries, maxilla-facial injuries, chest injuries, and soft tissue injuries are likely encountered and can be grievous with even fracture of extremities. The case fatality rate is also high. The attacks are implicated equally a measure out of self-defense or during provocation.7,27
In the electric current written report, injury patterns in nigh of the patients were lacerations and soft tissue injuries in the upper and lower extremities, except in victims of elephant attacks where edgeless injuries to the breast and abdomen predominated forth with extremity injuries. The findings are consistent with earlier studies that reported a predominance of soft tissue injuries and extremity injuries among beast set on victims.xv,28 Some authors have also highlighted the reason behind these extremity injuries as the animals are at ease to injure the moving body parts.seven,15,28 In our study, 54% of the patients underwent suturing and dressing in the ED. Around 31% of patients required splint or bandage awarding due to fracture or dislocation of the extremities. This is due to the injury pattern inflicted past wildlife past means of scratches and punctures with sharp teeth and nails and edgeless force in large mammals. The injuries sustained from animal attacks range from small bruises and contusions to deeper extensive injuries such as puncture wounds, avulsions, separation of punctured flaps, and even amputations.29,30 Our findings of suturing and dressing in nearly victims are consistent with the study of Gilyoma et al.15 that reported surgical wound debridement with either primary or delayed closure was the almost common procedure done on their patients of the animate being attack.
The complications from animal bites are mechanical injury by bite itself, local bacterial infection, and systemic infection. In animal bites, constructive wound management and prevention of infection should be the central goals. Meticulous examination to determine the extent of tissue harm, with attending for penetration into joint spaces and tendon sheath, and cleaning of the wound, including aggressive irrigation and debridement of devitalized tissue, is essential.10 The maxillofacial, perineal, and hand injuries can be challenging due to the proximity of anatomically important structures and should be managed effectively by plastic surgeons. Imaging should be done to detect fractures and rule out retained strange bodies such as animal teeth.10 Rubber broad-spectrum antibiotics to prevent and treat infections, along with anti-rabies treatment, is essential.10
The current study has some limitations which demand to be acknowledged while interpreting the study results. It was a unmarried-center report, limiting the generalizability of study findings. Secondly, as our center is a tertiary intendance infirmary, we received only a few referred cases. As most of the cases were treated in local hospitals or referred to land medical colleges, fewer patients were presented to ours. Yet, the actual magnitude of incidents is relatively high.
The study shed light on the cardinal epidemiological parameters, including the manner and injury patterns among victims of wild animal attacks from a state having diverse flora and fauna. The young male population were the major victims of wild-animal attacks, with the most mutual animal involved being the elephant. Almost victims had polytrauma, and the design of injury mostly specific for each animal. Future multicentre prospective studies are warranted to capture the exact magnitude of HWCs in this part of the world.
Upstanding statement
The approval was obtained from the institute ethics research commission (IEC Ref No: T/IM-NF/Gen.Surg/20/122).
Declaration of competing involvement
The authors declare no conflicts of involvement.
Footnotes
Peer review nether responsibility of Chinese Medical Clan.
References
three. Woodroffe R., Thirgood S., Rabinowitz A. In: People and Wild animals, Disharmonize or Co-existence? Conservation Biology. Rabinowitz A., Woodroffe R., Thirgood S., editors. Cambridge University Press; 2005. The future of coexistence: resolving human–wildlife conflicts in a changing world; pp. 388–405.https://doi:10.1017/CBO9780511614774.025 [Google Scholar]
x. Quinn J. In: Emergency Medicine. Tintinalli J.Eastward., Stapczynski J.Southward., Ma O.J., editors. McGraw-Colina; New York, NY: 2016. Puncture wounds and mammalian bites; pp. 313–321. [Google Scholar]
13. Vora D.H., Vora J.H. An epidemiological report of venomous snake bites: a infirmary based analysis. Natl J Customs Med. 2019;10:474–478. [Google Scholar]
15. Gilyoma J.Thousand., Mabula J.B., Chalya P.L. Animal-related injuries in a resource-express setting: experiences from a Third health establishment in northwestern Tanzania. World J Emerg Surg. 2013;viii:7. https://doi:10.1186/1749-7922-8-vii [PMC free article] [PubMed] [Google Scholar]
21. Mohanty C.R., Jain M., Radhakrishnan R.V., et al. In reply to article "A cross-exclusive study of epidemiological factors related to route traffic accidents in a metropolitan city". J Fam Med Prim Intendance. 2020;nine:2136. https://doi:10.4103/jfmpc.jfmpc_323_20 [PMC free commodity] [PubMed] [Google Scholar]
25. Jain G., Radhakrishnan R.V., Mohanty C.R., et al. Clinicoepidemiological profile of trauma patients albeit to the emergency department of a tertiary care infirmary in eastern Bharat. J Fam Med Prim Care. 2020;9:4974–4979. https://doi:ten.4103/jfmpc.jfmpc_621_20 [PMC gratis commodity] [PubMed] [Google Scholar]
26. Mohanty C.R., Radhakrishnan R.V., Jain Grand., et al. A study of the pattern of injuries sustained from route traffic accidents caused by impact with stray animals. J Emergencies, Trauma, Shock. 2021;14:23–27. doi: ten.4103/JETS.JETS_29_20. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
28. Aigner N., König Due south., Fritz A. Bissverletzungen und ihre besondere Stellung in der unfallchirurgischen Versorgung [Seize with teeth wounds and their feature position in trauma surgery management] Unfallchirurg. 1996;99:346–350. [PubMed] [Google Scholar]
29. Chalya P.L., Mchembe M., Gilyoma J.Thousand., et al. Bite injuries at Bugando medical centre, Mwanza, Tanzania: a five year experience. E Cent Afr J Surg. 2011;16 https://doi:ten.4314/ecajs.v16i1 [Google Scholar]
30. Callaham M., French S.P., Tetlow P., et al. In: Wilderness Medicine: Management of Wilderness and Environmental Emergencies. tertiary ed. Auerbach P.S., editor. Mosby-Yearbook; St. Louis: 1995. Bites and injuries inflicted by mammals; p. 943. [Google Scholar]
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8606701/
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