ABSTRACT
INTRODUCTION: This study analyses the cases of all bites (including dry bites) caused by Bothropoides jararaca attended at the Vital Brazil Hospital of the Butantan Institute, State of São Paulo, Brazil. METHODS: A retrospective study was conducted of patients bitten by Bothropoides jararaca (n=792) from January 1990 to December 2004. The characteristics of the snake specimen, data related to the accident and clinical manifestations on admission were obtained from patient medical records. RESULTS: The majority of the cases in this study were caused by female and juvenile snakes. No stomach contents were found in 93.4 percent of the snake specimens after dissection. No statistical difference was observed between the occurrence of dry bites and the maturity or sex of the snake. The median SVL of snakes in mild and moderate cases was 40.5cm and in severe cases, SVL increased to 99cm. Necrosis was more common in the digits of the feet and hands (4.8 percent) compared to the other body regions (1.8 percent). A significant difference was verified between severity and a time interval greater than six hours from the bite to hospital admission. A significant association was verified between gingival bleeding and abnormal blood coagulability. In accidents caused by adult snakes, necrosis was more frequent (7.2 percent) compared to accidents caused by juvenile snakes (1 percent). CONCLUSIONS: In this work, the association between certain epidemiological data and the evolution of biological parameters in the clinical course of Bothrops sensu latu accidents were highlighted, contributing to the improvement of snake bite assistance.
INTRODUÇÃO: Neste estudo, analisou-se todos os casos de picadas (incluindo picadas secas) causadas por Bothropoides jararaca atendidos no Hospital Vital Brazil do Instituto Butantan, São Paulo, Brasil. MÉTODOS: Estudo retrospectivo em que foram incluídos pacientes atendidos no Hospital Vital Brazil do Instituto Butantan, picados por serpentes da espécie Bothropoides jararaca (nº=792) entre 1990 a 2004. Os dados foram obtidos através de prontuários médicos. RESULTADOS: No presente estudo, a maioria dos acidentes foi causada por serpentes fêmeas e filhotes. Não havia presença de conteúdo estomacal em 93,4 por cento das serpentes dissecadas. Não houve diferença estatística entre a ocorrência de picada seca e o sexo da serpente. O comprimento rostro cloacal das serpentes nos casos leves e moderados foram 40,5cm e nos casos severos 99cm. Necrose foi mais comum nos dedos dos pés e das mãos (4,8 por cento) em comparação com outras regiões do corpo (1,8 por cento). Houve diferença estatística entre a gravidade e o intervalo de tempo entre a picada e a admissão hospitalar superior a seis horas. Encontramos uma associação significativa entre gengivorragia e incoagulabilidade sanguínea. Nos acidentes causados por serpentes adultas, a necrose foi mais frequente (7,2 por cento) quando comparado aos acidentes causados por serpentes filhotes (1 por cento). CONCLUSÕES: Neste estudo, destaca-se a associação entre os dados epidemiológicos e biológicos em relação à evolução do quadro clínico nos acidentes botrópicos, contribuindo para a melhoria da assistência nos acidentes ofídicos.
Subject(s)
Adult , Aged , Animals , Child , Female , Humans , Male , Bothrops , Snake Bites/epidemiology , Brazil/epidemiology , Retrospective Studies , Seasons , Severity of Illness Index , Snake Bites/pathology , Time FactorsABSTRACT
Bothrops alternatus venom was intramuscularly inoculated (3mg/kg) into 12 dogs, 30 to 65 days old. Spontaneou bleeding commenced twenty minutes later. Blood samples obtained 3 and 20 minutes after venom inoculation presented spontaneuous clotting formation. Plasmatic fibrinogen decreased within 3 minutes. Partial thromboplastin time (PTT) and one-stage prothrombin time (PT) were found. Plasma did not coagulate 40 minutes after inoculation. Platelet counts did not vary but their function was altered. Histopathology pointed out severe muscular necrosis and massive hemorrhage in the inoculation area. Regional ganglia showed intense hemorrhage. The 45 and 65-day-old animals showed alveolar thickening of the septum and generalized congestion, but the 30-day-old animals showed thrombosis of small arteries and arterioles. Renal lesions were different with the age. Cortical tubular necrosis was present in puppies, and intense cortical tubular hydropic degeneration was present in adult dogs. Thymus hemorrhage and necrosis were present.
Subject(s)
Animals , Dogs , Bothrops , Snake Bites/blood , Crotalid Venoms/blood , Blood Coagulation Factors , Partial Thromboplastin Time , Platelet Count , Snake Bites/pathologyABSTRACT
Renal lesions in ten patients following Russell's viper bite were studied. Renal biopsies were available in six and autopsies in four patients. Autopsied tissues from two cases of traumatic death served as controls. Both qualitative and quantitative changes in the glomeruli, tubules, interstitium and blood vessels were evaluated. Tubular necrosis was detected in five, tubular degeneration in nine, glomerular changes in nine and interstitial changes in four cases. Generally tissues from expired cases had more severe and extensive renal lesions than those that survived.
Subject(s)
Adolescent , Adult , Animals , Female , Humans , Kidney/pathology , Kidney Glomerulus/pathology , Kidney Tubules/pathology , Male , Middle Aged , Snake Bites/pathology , Snakes , Viper Venoms/toxicityABSTRACT
Se presentan dos casos de pacientes mordidos por serpientes del género Bothrops con evolución diferente que tuvieron paralelismo con su biopsia que mostraron necrosis cortical difusa (fallecido) y el otro caso necrosis tubular aguda (recuperado)
Subject(s)
Humans , Animals , Male , Adult , Middle Aged , Rabbits , Snake Bites/pathology , Acute Kidney Injury/pathology , Disseminated Intravascular Coagulation/etiology , Snake Bites/physiopathology , Snake Bites/therapy , Antivenins/therapeutic use , Acute Kidney Injury/physiopathology , Acute Kidney Injury/pathology , Kidney Cortex Necrosis/etiology , Kidney Cortex Necrosis/pathology , Kidney Tubular Necrosis, Acute/etiology , Kidney Tubular Necrosis, Acute/pathologyABSTRACT
Behavioural problems commonly occur in association with epilepsy and it has been generally observed that behaviour disturbances are the most frequent cause of psychiatric referral for epileptic children. This paper described the nature and extent of such disorders in a sample of 50 epileptic children. The data about behaviour disturbances were collected by using Rutter's questionnaire. The results are discussed with special reference to the practical implications of these findings in the assessment and management as well as in relation to some of the common factors associated with the aetiology of these disorders