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  1. J M Pappachan
  1. Dr J M Pappachan, Kottayam Medical College, Kottayam, Kerala, South India 686008; drpappachan{at}

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The concept of door to needle time/medical contact to needle time in the treatment of snakebite envenoming proposed by Professor Francis is important. In our study, all the patients who reached the emergency department of our institution directly with clinical and laboratory evidence of envenoming at the time of arrival received antivenom as soon as the diagnosis of envenoming was made.1 Hence, the medical contact to needle time could have been small and negligible. We could not estimate the medical contact to needle time in those …

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