Alterações oculares decorrentes de picada de abelha na córnea / Ocular changes due to corneal bee sting

RESUMO O propósito deste estudo foi reportar as alterações oculares observadas após picada de abelha com ferrão retido na córnea. Destacamos o tratamento e o desfecho de uma lesão de córnea incomum e sua patogênese. Trata-se de relato de caso e revisão da literatura de lesões oculares por picada de abelha. Paciente do sexo feminino, 63 anos, procurou atendimento oftalmológico de urgência devido à picada de abelha na córnea do olho direito há 6 dias. Queixava-se de embaçamento visual, dor e hiperemia ocular. Apresentou acuidade visual de vultos no olho afetado. Ao exame, notaram-se hiperemia moderada de conjuntiva bulbar, edema corneano com dobras de Descemet e presença do ferrão alojado na região temporal, no estroma profundo da córnea. A paciente foi internada para ser abordada no centro cirúrgico sob anestesia geral. Durante a cirurgia, o ferrão teve que ser retirado via câmara anterior, mediante a realização de uma paracentese e uma lavagem da câmara anterior, com dupla via e solução salina balanceada. Ainda não existe na literatura um tratamento padrão na abordagem de pacientes com lesões oculares por picada de abelha, sendo importantes a identificação e o reconhecimento precoce de possíveis complicações que ameacem a visão.

ABSTRACT The purpose of this study was to report the ocular changes observed after a bee sting with a stinger retained in the cornea. We show the treatment and outcome of an unusual corneal injury and its pathogenesis. This is a case report and literature review of ocular injuries caused by bee stings. A 63-year-old female patient sought emergency ophthalmic care because of a bee sting on the cornea of her right eye six days before. She complained of blurred vision, pain, and ocular hyperemia. She had glare sensitivity on visual acuity in the affected eye. Examination revealed moderate hyperemia of the bulbar conjunctiva, corneal edema with Descemet's folds and a stinger lodged in the temporal region, in the deep stroma of the cornea. The patient was admitted to the operating room under general anesthesia. During surgery, the stinger had to be removed via the anterior chamber, by performing a paracentesis and washing the anterior chamber with a double flushing and balanced saline solution. There is still no standard treatment in the literature for patients with eye injuries caused by bee stings, and early identification and recognition of possible sight-threatening complications is important.

Trends in occurrences of accidents by venomous animals in brazil: analysis of notifications from 2007 to 2021 / Tendências na ocorrência de acidentes por animais peçonhentos no brasil: análise das notificações de 2007 a 2021 / Tendencias en las ocurrencias de accidentes por animales venenosos en Brasil: análisis de las notificaciones de 2007 a 2021

Os acidentes por animais peçonhentos sãoum problema de saúde pública que apresenta elevado número de casos anuais no Brasil. Objetivo:descrever e analisar as ocorrências de acidentes por animais peçonhentos no Brasil e suas tendências entre 2007 e 2021.Metodologia:oestudo utilizou dados doSistema de Informação de Agravos de Notificação edo Sistema de Informação sobre Mortalidade.A população do estudo foi analisada segundo sexo, faixa etária e região de residência. A análise de tendência da série histórica foi realizada por regressão linear generalizada usando a estimação de Prais-Winsten.Resultados:as taxas de ocorrência padronizadas dobraram no período estudado (53,8/100.000 hab. em 2007 para 111,2/100.000 hab. em 2021). A região Nordeste apresentou a maior taxa de ocorrência padronizada (105,5/100.000 hab.). As regiões Nordeste, Sudeste e Centro-Oeste apresentaram maior taxa bruta de acidentes por escorpiões (75,8, 48,7 e 32,8 acidentes/100.000 hab., respectivamente), enquanto a região Norte por serpentes (54,2 acidentes/100.000 hab.) e a Região Sul por aranhas (60,3 acidentes/100.000 hab.). A taxa de mortalidade observada no período de 2007 a 2020 foi de 1,3 óbitos/1 milhão de hab. Entre as mortes registradas, 39,6% foram por picada de cobra.Conclusões:as tendências no Brasil foram ascendentes para ambos os sexos e para todas as faixas etárias. Apenas as regiões Norte e Sul apresentaram algumas categorias com tendências estacionárias. A análise dos dados epidemiológicos possibilita a identificação de populações-alvo e a elaboração de políticas públicas a fim de prevenir novos acidentes, bem como aprimorar o atendimento às pessoas acometidas por meio do planejamento da distribuição de soros antiofídicos (AU).

Accidents by venomous animals is a public health problem that presents a high number of annual cases in Brazil.Objective:to describe and analyze the occurrences of accidents by venomous animalsin Brazil and their trends between 2007 and 2021.Methodology:the study used Notifiable Diseases Information Systemand Mortality Information Systemdata. The study population wasanalyzed according to sex, age group, and region of residence. Trend analysis of the historical series was performed by generalized linear regression using Prais-Winsten estimation.Results:the standardized occurrence rates doubled during the studied period (53.8/100,000 inhab. in 2007 to 111.2/100,000 inhab. in 2021). The Northeast region had the highest standardized occurrence rate (105.5/100,000 inhab.). The Northeast, Southeast, and Midwest regions had a higher crude rate of accidents caused by scorpions (75.8, 48.7 and 32.8 accidents/100,000 inhab., respectively), while the North region by snakes (54.2 accidents/100,000 inhab.), and the South region by spiders (60.3 accidents/100,000 inhab.). Death rate observed in the period from 2007 to 2020 was 1.3deaths/1 million inhab. Among the deaths registered, 39.6% were from snakebite.Conclusions:trends in Brazil were ascendant for both sexes and for all age groups. Only the North and South regions showed some categories with stationary trends. The analysis of epidemiological data makes it possible the identification of target populations and elaborations of public policies in order to prevent new accidents, as well as the improvement of care for affected people by planning the distribution of antivenom serums (AU).

Los accidentes por animales venenosos son un problema de salud pública que presenta un elevado número de casos anuales en Brasil. Objetivo: describir y analizar lasocurrencias de accidentes por animales venenosos en Brasil y sus tendencias entre 2007 y 2021.Metodología: el estudio utilizó datos del sistema de información de enfermedades de declaración obligatoria(SINAN, según su sigla en portugués)ydelsistema de información de mortalidad. La población delestudio se analizó según sexo, grupo de edad y región de residencia. El análisis de tendencia de la serie histórica se realizó mediante regresión lineal generalizada utilizando la estimación de Prais-Winsten.Resultados: las tasas de ocurrencia estandarizadas se duplicaron durante el período estudiado (de 53,8/100000 hab. en 2007 a 111,2/100000 hab. en 2021). La región Nordeste presentó la mayor tasa de ocurrencia estandarizada (105,5/100000 hab.). Las regiones Nordeste, Sudeste y Medio Oeste presentaron la mayor tasa bruta de accidentes por alacranes (75,8, 48,7 y 32,8 accidentes/100000 hab., respectivamente), mientras que la región Norte por serpientes (54,2 accidentes/100000 hab.), y la Región Sur por arañas (60,3 accidentes/100000 hab.). La tasa de mortalidad observada en el período de 2007 a 2020 fue de 1,3 muertes/1 millón de hab. Entre las muertes registradas, el 39,6% fueron por mordedura de serpiente.Conclusiones: las tendencias en Brasil fueron ascendentes para ambos sexos y para todos los grupos de edad. Solo las regiones Norte y Sur presentaron algunas categorías con tendencias estacionarias. El análisis de datos epidemiológicos posibilita la identificación de poblaciones objetivo y la elaboración de políticas públicas para la prevención de nuevos accidentes, así como la mejora de la atención a las personas afectadas mediante la planificación de la distribución de sueros antiofídicos (AU).

A Study of Clinico-social Profile of Animal Bite Patients Attending the Antirabies Clinic of BRD Medical College, Gorakhpur

Background: Rabies is one of zoonotic viral disease, estimated to cause 59000 human deaths annually in over 150 countries, of which 20,000 are from India alone; about 40% of which are in children under the age of 15. Rabies though 100% fatal is preventable with post-exposure prophylaxis which includes wound washing, anti-rabies vaccination and rabies immunoglobulin. Objective: To describe the clinico-social profile of animal bite patients attending the anti-rabies clinic of BRD Medical College, Gorakhpur. Methodology: A cross-sectional study was conducted in the anti-rabies clinic of Nehru hospital, BRD Medical College, Gorakhpur from January 2022 to May 2022. Study participants were interviewed by using a pre-phrased, pre-designed and pre-tested questionnaire. Data regarding socio-demographic and clinical profile of the study participants following animal bite exposure was collected. Results: The total number of animal bite victims were 250, in which majority of them were males (76.77%) and highest percentage was of adult population (20-59 years). Maximum number of victims were from rural area (78.70%). 19.35% were working and 39.35% were students. 77.43% were category III bites and in 50.96% cases lower limb was the site of bite and dogs were responsible for 89.67% of the bites. 60.64% victims did not wash the wound properly before reaching the anti-rabies clinic. Conclusion: This study concludes that as majority of the animal bite victims were students and majority of victims were unaware about the importance of wound care, therefore a step can be taken to create awareness in various schools.

Picadura de insecto en la córnea, a propósito de un caso

Introducción : Es de vital importancia considerar que la toxina del veneno de la avispa puede ocasionar una reacción violenta que daña la función visual, es por ello que presentamos el siguiente caso relacionado. Cuadro Clínico : Mujer de 32 años con antecedente de picadura de avispa hace 24 horas en ojo derecho; disminución de la agudeza visual, enrojecimiento, lagrimeo, dolor, secreción; agudeza visual de cuenta dedos a 2 metros del ojo derecho y 20/25 ojo izquierdo, con presiones intraoculares de 12 y 13; biomicroscopía hiperemia conjuntival con inyección periciliar 3+, cuerpo extraño en córnea hasta estoma con edema 3+, estrías en la Descemet ojo derecho. Resultados : Se procede a la extracción del cuerpo extraño con previa protección antimicrobiana con antibiótico tobramicina, antiinflamatorio esteroideo prednisolona, hipertónicas y lubricante mixto carboximetilcelulosa y glicerina. A la semana, se observa la formación de una opacidad capsular anterior con signos de atrofia iridiana que empieza a dar un "cambio de color del iris", a las dos semanas se evidencia la dilatación de la vasculatura periciliar, a horas 4, y a las 3 semanas el paciente presenta una agudeza visual de 20/25 ambos ojos, con transparencia corneal, persistencia de la atrofia iridiana y catarata traumática capsular anterior, con remisión de sintomatología en el paciente. Conclusiones : No se sabe el componente exacto del veneno que produce los signos previamente descritos, existen teorías de que puede deberse a un componente con acción parasimpaticomimética, el mismo que se relaciona a otras observaciones clínicas de despigmentación local y heterocromía.

Introduction : It is very important to consider that the toxin present in wasp venom may lead to a severe reaction damaging visual function. This is the reason why we present the following case. Clinical Picture : This is a 32-year-old-female who was bitten by a wasp 24 hours ago in her right eye. She had visual acuity reduction, reddening, tearing, pain, and secretion. Her visual acuity was counting fingers at two-meter distance from her right eye and 20/25 in the left eye. Intraocular pressure was 12 and 13. Biomicroscopy showed conjunctival hiperemia with 3+ periciliary injection. There was a foreign body in the cornea towards the stoma, with 3+ edema. There were striae in the right Descemet. Resultados: We took out the foreign body with previous antimicrobial protection including an antibacterial (tobramycin) and a steroid anti-inflammatory compound (prednisolone). Hypertonic solution and mixed lubricants were also administered, including a mixed lubricant, carboxymethylcellulose, and glycerin. One week afterwards, we observed the formation of an anterior capsular opacity with signs of iris atrophy which led to a 'change of color in the iris'. Two weeks afterwards we observed periciliary vascular dilatation, at 4-hour meridian; and on the third week, the patient had 20/25 visual acuity in both eyes. Her cornea was transparent, there was persistence of iris atrophy, and there was an anterior capsular cataract. Her symptoms subsided. Conclusiones : The exact component of wasp venom leading to the described signs is not known. It has been proposed that it may be a compound with parasympathomimetic action, and this has been related with other clinical observations indicating local depigmentation and heterochromia.

Envenomations caused by fish in Brazil: an evolutionary, morphological, and clinical vision of a neglected problem

ABSTRACT Venomous fish are commonly found in Brazilian waters. The most important marine venomous fish species are stingrays (Dasyatidae, Gimnuridae, Myliobatidae, and Rhinopteridae families), catfish (Ariidae family), scorpionfish and lionfish (both Scorpaenidae family), and toadfish (Batrachoididae family). Meanwhile, Potamotrygonidae stingrays and Pimelodidae catfish are the most important venomous freshwater fish. The mechanisms of envenomation vary and involve various venomous apparatuses and glands. Despite not being highly developed, these venomous apparatuses in fish appear rudimentary, using structures such as fins and rays to inoculate toxins and rarely presenting with specialized structures. Toxins are produced by glandular tissue made up of proteinaceous cells, lacking true glands, and are positioned along the inoculation structures. However, systemic manifestations are rare. No antivenom serum has been developed for any species of American venomous fish. Brazilian venomous fish and their venoms have only recently attracted attention, leading to new studies not only addressing clinical issues in humans, but also exploring the discovery of new active substances with immense pharmacological potential.

Mapping of the venomous stingrays of the Potamotrygon genus in the Tietê River, São Paulo Sstate, Brazil

ABSTRACT Background: Freshwater stingrays are fish that have adapted to the rivers and lakes in South America. The expansion of the Potamotrygonidae family in the Paraná River began after the damming of the Sete Quedas Falls, reaching the mouth of the Paranapanema and Tietê rivers approximately 20 years ago via the locks of the hydroelectric power plants. They are not aggressive animals; however, they have one to four stingers on their tails covered by a venom-producing epithelium and can cause severe envenomation in fishermen and bathers if stepped on or manipulated. Methods: We conducted a descriptive, retrospective, and prospective study by monitoring the fishing of the Potamotrygon genus in the lower Tietê River, mapping the location of the rays as a fishery product of professional fishermen and/or recording images of the fish caught. Results: Sixteen stingrays of the Potamotrygon genus were mapped by monitoring fishermen's fish products in the extensive area between the municipalities of Pereira Barreto and Buritama, São Paulo state. Conclusions: The lower Tietê River is fully colonized by freshwater stingrays and this expansion likely continues upstream, reaching various sub-basins of the river. The advancement of these venomous fish in areas where they did not exist previously requires education programs and interaction with the community to avoid serious injuries in bathers and fishermen and the unreasonable extermination of the animals.

Centipede envenomation (Chilopoda): Case report

ABSTRACT Centipedes are venomous arthropods that have an elongated body, divided into many segments, presenting a pair of legs in each segment, adapted pairs of paws that simulate fangs and inject venom causing intense pain, with local erythema and edema, and rarely, blisters and skin necrosis. We present the case of a young woman pricked on her upper lip with intense swelling and local pain and discuss the real danger of envenomation and the therapeutic measures that should be taken.

Risk factors of acute kidney injury in patients with multiple wasp stings / 中华肾脏病杂志

Objective:To evaluate the risk factors of acute kidney injury (AKI) in patients with multiple wasp stings.Methods:Patients with multiple wasp stings were retrospectively enrolled in Hanzhong Central Hospital from September 2010 to November 2020. Based on whether the patients developed AKI, the patients were divided into AKI group and non-AKI group. The general characteristics and laboratory examinations between the two groups were compared. The logistic regression model was used to analyze the risk factors of AKI.Results:A total of 356 patients with multiple wasp stings were recruited in this study, with 196 males (55.1%). The age was 56.0(45.0, 64.0) years old. There were 59 patients (16.6%) with hypertension and 13 patients (3.6%) with diabetes. There were 51 patients (14.3%) in the AKI group and 305 patients (85.7%) in the non-AKI group. Baseline data and biochemical examinations indicated that the two groups showed significant differences in gender, age, sting sites (systemic or local), sting needles, proportions of gross hematuria, leukocyte count, hemoglobin, creatine kinase, alanine transaminase, aspartate aminotransferase, total bilirubin, proportions of urinary protein, and proportions of urine occult blood (all P<0.05). The multivariate logistic regression analysis results showed that the increasing number of sting needles (every 10 needles increase, OR=1.866, 95% CI 1.289-2.071, P=0.001), gross hematuria ( OR=9.770, 95% CI 2.586-36.910, P=0.001), decreasing hemoglobin (every 1 g/L increase, OR=0.016, 95% CI 0.001-0.355, P=0.009), increasing aspartate aminotransferase (every 100 U/L increase, OR=1.311, 95% CI 1.144-1.502, P<0.001), and increasing total bilirubin (every 10 μmol/L increase, OR=1.200, 95% CI 1.008-1.430, P=0.041) were independent influencing factors of AKI. Conclusions:The increasing number of sting needles, gross hematuria, decreasing hemoglobin, increasing aspartate aminotransferase, and increasing total bilirubin are independent risk factors of AKI in patients with multiple wasp stings.

Fatores associados aos óbitos e ataques de tubarão: um estudo transversal / Factors associated with shark attacks and deaths: a crosssectional study / Factores asociados con las muertes y los ataques de tiburones: estudio transversal

OBJETIVO: avaliar os fatores associados aos óbitos e ataques de tubarão no Brasil. MÉTODO: trata-se de um estudo transversal, quantitativo, realizado mediante acesso virtual ao website do Global Shark Attack File. A análise foi realizada no programa R, a partir de estatística descritiva e dos testes de Qui-quadrado de Pearson e Teste Exato de Fisher. RESULTADOS: ocorreram 86 ataques, dos quais 26 (30,2%) resultaram em óbito. Foi encontrada associação entre a ocorrência de ataque com o ano, estado, região, dia da semana, turno e espécie do tubarão, além da faixa etária, sexo da vítima e local do corpo acometido. Nenhuma variável apresentou associação com o óbito. O estado de Pernambuco computou o maior número de ataques (83,7%) e óbitos (96,2%). CONCLUSÃO: os ataques de tubarão estiveram associados com nove variáveis: três de caracterização da vítima e seis do perfil do acidente. Os óbitos não apresentaram associação significativa. Pernambuco sobressaiu como estado com maior ocorrência de ataque e óbitos.

OBJECTIVE: to evaluate the factors associated with shark attacks and deaths in Brazil. METHOD: this is a cross-sectional and quantitative study, carried out through virtual access to the Global Shark Attack File website. The analysis was performed in the R program, using descriptive statistics and the Pearson's chi-square and Fisher's exact tests. RESULTS: there were 86 attacks, of which 26 (30.2%) resulted in deaths. An association was found between occurrence of the attacks and year, state, region, day of the week, shift and shark species, in addition to the victim's age group and gender and to the part of the body affected. No variable was associated with death as outcome. The state of Pernambuco accounted for the largest number of attacks (83.7%) and deaths (96.2%). CONCLUSION: shark attacks were associated with nine variables: three related to the victim's characterization and six to the profile of the accident. The deaths did not present a significant association. Pernambuco stood out as the state with the highest occurrence of attacks and deaths.

OBJETIVO: evaluar los factores asociados con las muertes y los ataques de tiburones en Brasil. MÉTODO: se trata de un estudio transversal, cuantitativo, realizado a través del acceso virtual al sitio web Global Shark Attack File. El análisis se realizó mediante el programa R, utilizando estadística descriptiva y chi-cuadrado de Pearson y prueba exacta de Fisher. RESULTADOS: hubo 86 ataques, de los cuales 26 (30,2%) resultaron en muerte. Se encontró que hay asociación entre el ataque y el año, estado, región, día de la semana, turno y especie de tiburón, además del rango etario, sexo de la víctima y parte del cuerpo afectada. Ninguna variable se asoció con la muerte. El estado de Pernambuco tuvo el mayor número de ataques (83,7%) y muertes (96,2%). CONCLUSIÓN: los ataques de tiburones se asociaron con nueve variables: tres de la caracterización de la víctima y seis del perfil del accidente. Las muertes no mostraron una asociación significativa. Pernambuco se destacó como el estado con mayor número de ataques y muertes.

Medically important ants: a systematic review of the global distribution and clinical consequences of their bites and stings / Hormigas de importancia médica: revisión sistemática de su distribución global y consecuencias clínicas de sus mordeduras y picaduras

Introduction: From the medical point of view, only some ants are of special interest. Due to the diversity of ants and the growing contact with humans, it is necessary to have a better understanding of the factors and problems, which lead to adverse clinical outcomes. Objective: The aim of this study was to conduct a systematic review of published studies on ants and their impact on the medical field to synthesize fragmented knowledge and to inform the current state of this problem. Methods: A systematic literature review was conducted in Medline, EMBASE, SciELO and Google Scholar, with no time threshold. The search strategy was limited to articles published in Portuguese, English and Spanish. Eligible studies were case reports and case series that reported outcomes in humans caused by ant stings. Patient-level and study-level information was extracted. Results: The literature search yielded 1909 studies; of which 30 case reports and 16 case series reporting a total of 95 cases were included. Of these 48 patients were women (50.5 percent, and the median age was 36.1 ± 25.5 years old. The most frequently reported complications were severe pain, anaphylaxis and acute respiratory distress syndrome. The death of eighteen patients was documented (18.9 percent). Ants from the genera Solenopsis spp., Myrmecia sp., Paraponera clavata, Pachycondyla sennaarensis, Myrmecia rubra caused most of the accidents Conclusions: Severe allergic reactions caused by ants are a rare event, however, mortality can be high. An increase of ant related accidents is expected, a quick diagnosis and treatment is necessary to avoid fatalities(AU)

Introducción: Desde el punto de vista médico, solo algunas hormigas son de especial interés. Debido a la diversidad de hormigas y al creciente contacto con humanos, es necesario comprender mejor los factores y problemas que conducen a resultados clínicos adversos. Objetivo: Realizar una revisión sistemática de estudios publicados sobre las hormigas y su impacto en el campo médico para sintetizar conocimientos fragmentados e informar sobre el estado actual del problema. Métodos: Se realizó una revisión bibliográfica sistemática en Medline, EMBASE, SciELO y Google Scholar, sin límite de tiempo. La estrategia de búsqueda se limitó a artículos publicados en portugués, inglés y español. Se seleccionaron informes y series de casos sobre consecuencias de las picaduras de hormigas en humanos. Se extrajo información a nivel de paciente y a nivel de estudio. Resultados: La búsqueda bibliográfica obtuvo 1 909 estudios, de los cuales se seleccionaron 30 informes y 16 series sobre un total de 95 casos. De estos, 48 pacientes eran mujeres (50,5 por ciento) y la media de edad era 36,1 ± 25,5 años. Las complicaciones más frecuentes fueron dolor intenso, anafilaxia y síndrome de dificultad respiratoria aguda. Se documentó la muerte de 18 pacientes (18,9 por ciento). Hormigas de los géneros Solenopsis spp., Myrmecia sp., Paraponera clavata, Pachycondyla sennaarensis y Myrmecia rubra causaron la mayoría de los accidentes. Conclusiones: Las reacciones alérgicas graves provocadas por hormigas son un evento raro; sin embargo, la mortalidad puede ser alta. Se espera un incremento de los accidentes relacionados con las hormigas. Se requiere un diagnóstico y tratamiento rápidos para evitar muertes(AU)

Perfil epidemiológico de acidentes com animais peçonhentos no estado do maranhão / Epidemiological profile of accidents involving poisony animals in the stateof Maranhão / Perfil epidemiológico de accidentes con animales venenosos en el estado del Maranhão

Introdução: Acidentes causados por animais peçonhentos são considerados um problema de saúde pública, sendo responsáveis por considerável número de agravos à população mundial. Estudos acerca do tema são escassos no Maranhão, havendo a necessidade de investigação dos casos, visto que são de fundamental importância para as ações de vigilância epidemiológica e ambiental. Objetivo: Descrever o perfil epidemiológico dos acidentes com animais peçonhentos no Estado do Maranhão, Brasil. Metodologia: Trata-se de estudo ecológico, descritivo com abordagem quantitativa. Os dados foram coletados no Sistema de Informação de Agravos de Notificação/Departamento de Informática do Sistema Único de Saúde ocorridos no período de 01 janeiro de 2009 a 31 de dezembro 2019 dos casos notificados de acidentes com animais peçonhentos. Resultados: Constou-se maior incidência de notificações de acidentes em 2019,nos meses de Fevereiro (10,14%), Março (9,96%) e Maio (9,89%). No que tange ao perfil das vítimas houve uma predominância no sexo masculino (68,16%), adultos jovens de 20 a 39 anos (36,24%) e autodeclarados pretos (75,03%). No que diz respeito à gestação a imensa maioria não se aplica a categoria gestante (77,71%). Em relação as características do acidente destacou-se o acidente escorpiônico (55,97%), seguido pelos acidentes com aranhas (30,66%) e ofídicos (4,09%). O tempo decorrido entre o acidente e o atendimento foi predominante no intervalo de 1 a 3 horas após o acidente (34,37%). Dos acidentes ocorridos 61,31% foram classificados como leves, 82,02% evoluíram clinicamente com cura e 0,6% para óbito. Conclusões: Os acidentes causados por animais peçonhentos são de relevância para que haja um planejamento com medidas intersetoriais de vigilância epidemiológica junto a outros órgãos ambientais para minimizar o número de mortes (AU).

Introduction:Acidents caused by venomous animals are considered a public health problem, being responsible for a considerable number of injuries to the world population. Studies on the theme are scarce, with the need to investigate the cases,since they are of fundamental importance for the actions of epidemiological and environmental surveillance.Objective:To describe the epidemiological profile of accidents with venomous animals in the state of Maranhão, Brazil. Methodology:This is an ecological, descriptive study with a quantitative approach. Data were collected at Information System for Notifiable Diseases / Informatics Department of the Unified Health System from January 1, 2009 to December 31, 2019 of the reported cases of accidents with venomous animals. Results:There was a higher incidence of accident notifications in 2019 and in the months of February (10.14%), March (9.96%) and May (9.89%). Regarding the profile of the victims, there was a predominance of males (68.16%), young adults aged 20 to 39 years (36.24%) and self-declared blacks (75.03%). With regard to pregnancy, the vast majority does not apply to the pregnant category (77.71%). Regarding the characteristics of the accident, the scorpionic accident stood out (55.97%), followed by accidents with spiders (30.66%) and snakebites (4.09%). The time elapsed between the accident and the assistance was predominant in the interval from 1 to 3 hoursafterthe accident (34.37%). Of the accidents that occurred, 61.31% were classified as mild, 82.02% progressed clinically with cure and 0.6% died. Conclusions:Accidents caused by venomous animals are relevant for planning intersectoral measures for epidemiological surveillance with other environmental agencies to minimize the number of deaths (AU).

Introducción: Los accidentes ocasionados por animales venenosos son considerados un problema de salud pública, siendo responsable de un número considerable de lesiones a la población mundial. Los estudios sobre el tema son escasos,con la necesidad de investigar los casos, ya que son de fundamental importancia para las acciones de vigilancia epidemiológica y ambiental. Objetivo: Describir el perfil epidemiológico de accidentes con animales venenosos en el estado de Maranhão, Brasil. Metodología:Se trata de un estudio ecológico, descriptivo con enfoque cuantitativo. Los datos fueron recolectados en el Sistema de Información de Enfermedades Notificables /Departamento de Informática del Sistema Único de Salud que ocurrieron en el período del 01 de enero de 2009 al 31 de diciembre de 2019 de los casos notificados de accidentes con animales venenosos.Resultados: Hubo una mayor incidencia de notificaciones de accidentes en 2019 y en los meses de febrero (10,14%), marzo (9,96%) y mayo (9,89%). En cuanto al perfil de las víctimas,predominó el sexo masculino (68,16%), adultos jóvenes de 20 a 39 años (36,24%) y negros autodeclarados (75,03%). En cuanto al embarazo, la gran mayoría no aplica a la categoría de embarazadas (77,71%). En cuanto a las características del accidente, destacó el accidente escorpiónico (55,97%), seguido de los accidentes con arañas (30,66%) y las mordeduras de serpientes (4,09%). El tiempo transcurrido entre el accidente y la asistencia fue predominante en el intervalo de 1 a 3 horasposteriores al accidente (34,37%). De los accidentes ocurridos, 61,31% fueron clasificados como leves, 82,02% progresó clínicamente con curación y 0,6% fallecieron. Conclusiones: Los accidentes causados por animales venenosos son relevantes para planificar medidas intersectoriales de vigilancia epidemiológica con otras agencias ambientales para minimizar el número de muertes (AU).

Acute bullous hemorrhagic prurigo: a diagnostic challenge

Abstract Insect bites and bite wounds are quite common and most often have mild repercussions in humans. Statistics on the incidence of accidents caused by insects are not available, and the skin reactions after the bites are not always known. The authors present two cases of patients with hemorrhagic blisters on their hands after tabanidae bites and discuss the factors that cause the problem and the importance of the differential diagnosis of blisters with hemorrhagic content on human skin.

Nephrotic syndrome after insect sting: a case report / Síndrome nefrótica após picada de inseto: relato de caso

ABSTRACT Minimal change disease accounts for up to 25% of the cases of nephrotic syndrome in adult population. The allergic mechanism has been associated with minimal change disease and allergens have been implied, namely insect stings. We present a case report of a woman with new onset of nephrotic syndrome after a non-hymenoptera insect sting, with biopsy-proven minimal change disease, that was accompanied by a pulmonary thromboembolism process. Complete remission with glucocorticoid therapy was observed, with sustained response for 6 months after discontinuation. A new exposure to insect sting in the same geographical region and season triggered a nephrotic syndrome relapse. Subsequent avoidance of the place resulted in a sustained remission for more than 4 years.

RESUMO A doença de lesões mínimas é responsável por até 25% dos casos de síndrome nefrótica na população adulta. O mecanismo alérgico tem sido associado à doença de lesão mínima a associada a alérgenos, como picadas de insetos. Apresentamos um caso de uma mulher com início recente de síndrome nefrótica após picada de inseto não himenóptero, com doença de lesões mínimas comprovada por biópsia, acompanhada por um processo de tromboembolismo pulmonar. A paciente teve remissão completa com glicocorticoides, com resposta sustentada por 6 meses após a interrupção do tratamento. Uma nova exposição à picada de inseto na mesma região geográfica e estação do ano provocou uma recaída da síndrome nefrótica. Evitar o local subsequentemente resultou em remissão sustentada por mais de 4 anos.

Maxillofacial management of dog bites injuries in an infant: A case report / Manejo maxillofacial por mordeduras de perro en un infante: Reporte de un caso / Manejo maxilofacial de mordidas de cães em criança: Relato de caso

Abstract Dog bites cause complex craniomaxillofacial injuries. Considering that the bite injuries are repeatedly situated on the face, dentist requires being well known with the therapy of animal bites. A three-year-old male child was attended as a victim of a Pit Bull terrier biting. The patient had multiple wounds at the level of the upper eyelid of the right eyeball, left hemisphere with the involvement of the auricular pavilion, wounds with multiple detachments on face and scalp, several abrasions and ecchymoses in the bilateral infraorbital and mouth region. The clinical intervention was completed in the first twenty-four hours after injury. The affected zones were cleaned and irrigated with saline solution, and the wounds were sutured in layers. Tetanus and anti-rabies vaccination, and antibiotic and analgesic were administered. On the fifth postoperative day, the stitches were removed, and the patient was discharged from the hospital. One week after the trauma, the child showed adequate wound curing absent of aggravation. Satisfactory aesthetic and functional results were achieved. Besides, in this case, the most relevant aspects of the management of dogs bites are presented.

Resumen Las mordeduras de perros causan lesiones craneomaxilofaciales complejas. Teniendo en cuenta que las lesiones por mordedura están situadas repetidamente en la cara, el odontólogo debe conocer la terapia que se debe realizar en el caso de mordeduras de animales. Un niño de tres años fue atendido como víctima de una mordedura de Pit Bull terrier. El paciente tenía múltiples heridas a nivel del párpado superior del globo ocular derecho, hemisferio izquierdo con afectación del pabellón auricular, heridas con múltiples desprendimientos en la cara y el cuero cabelludo, varias abrasiones y equimosis en la región bilateral infraorbitaria y bucal. La intervención clínica se completó en las primeras veinticuatro horas después de la lesión. Las zonas afectadas se limpiaron e irrigaron con solución salina, y las heridas se suturaron en capas. Se administraron vacuna antitetánica y antirrábica, antibióticos y analgésicos. En el quinto día postoperatorio, se retiraron los puntos de sutura y el paciente fue dado de alta del hospital. Una semana después del trauma, el niño mostró curación adecuada de la herida sin agravación. Se lograron resultados estéticos y funcionales satisfactorios. Además, en este caso, se presentan los aspectos más relevantes del manejo de las mordeduras de perros.

Resumo Mordidas de cães causam lesões craniomaxilofaciais complexas. Considerando que as lesões por mordidas são repetidamente situadas na face, um cirurgião oral e maxilofacial exige ser bem conhecido com a terapia de mordidas de animais. Um menino de três anos foi vítima de uma picada de um terrier de Pit Bull. O paciente apresentava múltiplas feridas no nível da pálpebra superior do globo ocular direito, hemisfério esquerdo com envolvimento do pavilhão auricular, feridas com múltiplos descolamentos na face e couro cabeludo, várias abrasões e equimoses na região infraorbital e boca bilateral. A intervenção clínica foi concluída nas primeiras vinte e quatro horas após a lesão. As zonas afetadas foram limpas e irrigadas com solução salina e as feridas foram suturadas em camadas. Vacinação antitetânica e anti-rábica e antibióticos e analgésicos foram administrados. No quinto dia de pós-operatório, os pontos foram retirados e a paciente recebeu alta do hospital. Uma semana após o trauma, a criança apresentou cura adequada da ferida, sem agravamento. Resultados estéticos e funcionais satisfatórios foram alcançados. Além disso, neste caso, são apresentados os aspectos mais relevantes no manejo das mordidas de cães.

Profile of skin diseases in a community of fishermen in the northern coast of the state of São Paulo: the expected and the unusual

Abstract: Background: The fishing colony of the Picinguaba neighborhood is located at the northern end of the coast of the state of São Paulo. It has about 300 residents, of which approximately 100 are professional fishermen. Objectives: This study aimed to identify the main dermatoses of the community in comparison with other populations, and their frequency. Methods: The dermatoses were identified and tabulated for two years, in a prospective study carried out on monthly trips to the fishermen's colony in Picinguaba. Results: One hundred and eighteen patients were attended and followed up, which is equivalent to about 1/3 of the colony's inhabitants. Of these, 43 were children (under the age of 14) and 75 were adolescents and adults. The diseases observed were catalogued according to the age groups. Although most dermatoses in the community were similar with those observed in the general population, some specific cases could be seen, such as folliculitis on the legs of fishermen and an unexpected low frequency of actinic lesions in the colony, as well as dermatitis by aquatic animals. Study Limitations: The limitations were monthly attendance and the spontaneous demand of the patients. Conclusions: The finding of community-specific dermatoses and the low incidence of malignant and pre-malignant tumors associated with sun exposure needs further studies for better clarification.

Oral microbiota and their antibiotic susceptibility in free-living monkeys in Goiás State, Brazil: Repercussions for injuries in humans

Abstract INTRODUCTION: Goiás State, which is in the midwest region of Brazil, has several urban forests. This fact, along with the expansion of urban areas within the limits of Forest Conservation Units, increases the contact between humans and wildlife, such as capuchin monkeys. The impulsive behavior of these animals and the scarcity of food cause them to vigorously search for food, leading to direct encounters with Park visitors, which can result in scratches and bites and making them potential disseminators of pathogenic microorganisms. METHODS: Ten specimens of bearded capuchin monkey (Sapajus libidinosus) were captured at the Onofre Quinan Environmental Park in Anápolis, Goiás, Brazil. Samples were collected from the monkeys, and the bacteria and fungi present in the samples were isolated and identified. Then, the identified microorganisms were subjected to antibiotic susceptibility testing. RESULTS: A total of 111 bacteria and 12 fungi were isolated, including two strict anaerobic bacteria of the genus Peptostreptococcus, 109 facultative anaerobic bacteria, and 12 yeasts. Among the facultative bacteria, enterobacteria and Staphylococcus were common. Resistance to tetracycline and ampicillin antibiotics was detected in the enterobacteria, and resistance to tetracycline, erythromycin, and clindamycin was detected in the Staphylococci. The other strains were sensitive to all tested antimicrobials. Cefoxitin showed 100% efficacy in all isolated bacteria. CONCLUSIONS: For bites from capuchin monkeys, we recommend performing complete hygiene and antibiotic therapy, according to medical recommendations. Given the 100% effectiveness of cefoxitin, it should be considered for this type of injury, especially in the study region.

Domestic infestation by Sclerodermus sp. with associated skin manifestation

Abstract: Sclerodermus sp. is an aculeate insect (Hymenoptera: Bethylidae), measuring 2-4 mm in length. It is a parasitoid and needs termites as hosts to complete its life cycle. It is found in a wide variety of woods and may accidentally sting humans who come near affected wooden objects. A 50-year-old woman presented two episodes of intense pruritic lesions. Clinical diagnosis of insect bite was doubtful since there were no pets at home, lesions had not started during summer and the patient denied rural activities. During a night episode of itching, the patient examined her bed and found 8 insects likely to be responsible for the bites. Scanning electron microscopy revealed typical features of a female of the genus (wingless and with multiple stingers at the lower end of the abdomen).

Lesão labial por mordedura animal em criança: relato de caso / Lip injury by animal bite

As mordeduras de animais estão entre os tipos mais comuns de traumatismos, aos quais o homem está exposto, em que os ferimentos em face representam 15% dos atendimentos hospitalares de emergência, e a infecção é a principal complicação associada. Essas injúrias acometem duas vezes mais crianças, com comprometimento das regiões de nariz, orelha, bochechas e lábios. Apresentam-se desde abrasões superficiais até ferimentos profundos, causando prejuízos estéticos e funcionais às vítimas. O objetivo deste trabalho é mostrar a conduta frente a essas lesões, que ainda não é consensual, principalmente do ponto de vista do fechamento primário da ferida e da antibioticoterapia profilática para doenças infectocontagiosas, originadas a partir do contato da saliva do animal com a ferida. Paciente, 1 ano e 4 meses, vítima de mordedura animal, atendida pelo Serviço de Cirurgia e Traumatologia Buco Maxilo Facial do Hospital de Emergência e Trauma Senador Humberto Lucena, João Pessoa - PB, tratado, sob anestesia geral, por reparo primário, associado à antibioticoterapia e imunização antitetânica, evoluindo sem sinais flogísticos e com resultado estético satisfatório. Frente a casos de mordedura animal, o profissional deve estar apto a reconhecer, diagnosticar e indicar a terapia correta. Ainda para esses ferimentos em face, vale a indicação de fechamento primário destas, por questões estéticas e por se tratar de uma região ricamente vascularizada... (AU)

Animal bites are among the most common types of trauma to which the man is exposed, where face injuries account for 15% of emergency hospital visits, and infection is the main complication associated. These injuries affect children twice, with involvement of the nose, ear, cheeks and lips. They range from superficial abrasions to deep wounds, causing aesthetic and functional damage to the victims. The aim of this study is to show the behavior of these lesions, which is still not consensual, mainly from the point of view of the primary closure of the wound and the prophylactic antibiotic therapy for infectocontacting diseases, originated from the contact of the saliva of the animal with the wound. Patient, 1 year and 4 months, victim of animal bite, attended by the Service of Maxillofacial Surgery and Traumatology of the Hospital of Emergency and Trauma Senador Humberto Lucena, João Pessoa-PB, treated, under general anesthesia, by primary repair, associated with antibiotic therapy and tetanus immunization, evolving without phlogistic signs and with a satisfactory aesthetic result. Faced with cases of animal bite the professional must be able to recognize, diagnose and indicate the correct therapy. Still for these injuries in face it is worth indicating the primary closure of the same ones, for esthetic reasons and because it is a richly vascularized region... (AU)

La pérdida de la percepción al riesgo de zoonosis y la figura del perro comunitario / Loss of risk perception to zoonoses and the figure of community dog

Resumen Los perros son causantes de zoonosis y lesiones; en especial, si aceptamos como normales conductas peligrosas; perdiendo la percepción al riesgo a enfermar. El objetivo de este manuscrito fue demostrar, que la presencia de perros vagos y comunitarios, es un peligro para la salud y seguridad pública, a través de información epidemiológica que sustenta la medida de evitar su libre circulación. La agresividad de los perros regula sus relaciones sociales a través de sumisión o dominancia; características de difícil reconocimiento para la población humana. En Chile, 327.150 personas resultaron mordidas por perros, entre los años 2003-2012, con un costo de U$22,7 a U$177,9 millones; además de los U$3,13 millones por intervenir quirúrgicamente 767 sujetos humanos de hidatidosis durante el año 2012. Sin embargo, la zoonosis más temida es la rabia, dado el resultado mortal de ésta. No se debe tolerar la presencia de perros vagos y comunitarios en las calles, medida que debe tener un sustento técnico de salud y seguridad pública; debido a que la población ha perdido la capacidad de percibir el riesgo de contraer enfermedades zoonóticas, de altos costos para el sistema asistencial; sin considerar el desmedro económico al núcleo familiar y el daño psicológico a los afectados.

Dogs may cause zoonoses and damages; especially when we accept as normal some dangerous behavior, losing the perception of disease risk. The purpose of this review was to demonstrate that the presence of stray dogs as well as community dogs, are public health hazard. Through sustainable epidemiological information, we believe this measure could prevent it from spreading. Dog's aggressiveness regulates its social relationships through submission or dominance; those characteristics are difficult to be recognized by human population. In Chile, 327.150 people were bitten by dogs, between years 2003 and 2012 with a cost of USD$22.7 to USD$177,9 million in addition to the USD$3,13 million for the surgical intervention of 767 human subjects of Hydatidosis during 2012. However zoonosis more dangerous is Rabies with death results. As a conclusion we state that the presence of stray and community dogs in the streets cannot be tolerated. This measure must have a sustainable technical of Health and Public safety because population have lost its ability of recognize the risk of contracting zoonotic diseases, with high costs for the health care system, besides the economical decline and psychological damage to the affected individuals.

Skin manifestations of tick bites in humans

Abstract: Ticks are blood-sucking arthropods that attach to human skin through oral devices causing diverse initial cutaneous manifestations, and may also transmit serious infectious diseases. In certain situations, the Health Teams (and especially dermatologists) may face difficulties in identifying the lesions and associating them to the parasites. To assist them in clinical diagnosis, we suggest a classification of the skin manifestations in primary lesions, which occur by the attachment the tick to the host (for toxicity and the anticoagulant substances in the saliva and/or marked inflammation by the penetration and permanence of the mouthparts) and secondary lesions that are manifestations of infections caused by rickettsia, bacteria, protozoa and fungi inoculated by the ticks.