Understanding the complexity of Tityus serrulatus venom: A focus on high molecular weight components

Tityus serrulatus scorpion is responsible for a significant number of envenomings in Brazil, ranging from mild to severe, and in some cases, leading to fatalities. While supportive care is the primary treatment modality, moderate and severe cases require antivenom administration despite potential limitations and adverse effects. The remarkable proliferation of T. serrulatus scorpions, attributed to their biology and asexual reproduction, contributes to a high incidence of envenomation. T. serrulatus scorpion venom predominantly consists of short proteins acting as neurotoxins (α and ß), that primarily target ion channels. Nevertheless, high molecular weight compounds, including metalloproteases, serine proteases, phospholipases, and hyaluronidases, are also present in the venom. These compounds play a crucial role in envenomation, influencing the severity of symptoms and the spread of venom. This review endeavors to comprehensively understand the T. serrulatus scorpion venom by elucidating the primary high molecular weight compounds and exploring their potential contributions to envenomation. Understanding these compounds' mechanisms of action can aid in developing more effective treatments and prevention strategies, ultimately mitigating the impact of scorpion envenomation on public health in Brazil.

Secondary infection profile after snakebite treated at a tertiary referral center in the Brazilian Amazon

ABSTRACT Background: Bothrops envenomations can often lead to complications, such as secondary infections. Methods: This cross-sectional study analyzed the medical records of all patients diagnosed with snakebite. Results: A total of 127 patients were included. Clindamycin was the most commonly prescribed antibiotic, with 105 patients (82.7%) receiving it as the primary antibiotic regimen. In 31 (24.4%) individuals, the first-choice antibiotic did not cease the infection. Conclusions: Secondary infection is an important complication resulting from snakebites, and evidence-based management of this complication can contribute to better clinical outcomes.

When to think about a Lachesis muta envenomation in the Western Brazilian Amazon: Lessons from a case report

ABSTRACT In the Brazilian Amazon, envenomations by lancehead pit vipers prevail across the region, while bushmaster (Lachesis muta) envenomations are rarely confirmed. Here, we described a moderate snakebite, diagnosed as a lancehead pit viper envenomation upon admission and treated with four vials of Bothrops antivenom. Blood remained unclottable for 4 days of hospitalization. On day 4, after admission, the patient presented pictures of the perpetrating snake to the hospital staff, which was identified as a Lachesis muta specimen. After administering 10 vials of Lachesis antivenom, blood became clottable 12 hours after treatment. The patient was discharged without complaints.

Experience report of the contributions of telehealth in riverside communities of Amazonas in the pandemic / Relato de experiencia de las contribuciones de la telesalud en comunidades ribereñas de Amazonas en la pandemia / Relato de experiência das contribuições da telessaúde em comunidades ribeirinhas do Amazonas na pandemia

ABSTRACT Objective: to report on the creation and implementation of telehealth activities developed by the Forest Health Program in communities in conservation areas, in the state of Amazonas, during the COVID-19 pandemic. Methods: this is an experience report on the creation and implementation of the program. Results: the project began in June 2021 with medical and nursing services and currently has 63 points of connectivity installed. Dermatology was the most requested specialty (30.1%), with dermatitis being the main grievance diagnosed. For nursing, the most requested specialty was obstetrics, followed by pediatrics. Rio Madeira and the Catuá-Ipixema Extractive Reserve requested more than half of all consultations. Conclusion: this project showed a differentiated performance of telehealth in riverside communities in Amazonas, especially in the pandemic context, expanding health care in remote areas, such as these.

RESUMEN Objetivo: Relatar la creación e implementación de actividades de telesalud desarrolladas por Programa Salud en la Floresta en comunidades de áreas de conservación, en el estado de Amazonas, durante la pandemia de COVID-19. Métodos: Relato de experiencia sobre la creación e implementación del programa. Resultados: El proyecto tubo inicio en junio de 2021 con atenciones en el área de medicina y enfermería y actualmente cuenta con 63 puntos de conectividad instalados. La dermatología fue la especialidad más requerida (30,1%), con las dermatitis siendo el principal agravio diagnosticado. En enfermería, la especialidad más solicitada fue en el área de obstetricia, seguida por pediatría. Río Madeira y la Reserva Extractivista Catuá-Ipixema solicitaron más de la mitad de todas las atenciones. Conclusión: Este proyecto mostró una actuación diferenciada de telesalud en comunidades ribereñas de Amazonas, especialmente en el contexto pandémico, ampliando el cuidado a salud en áreas remotas, como estas en cuestión.

RESUMO Objetivo: Relatar a criação e implementação das atividades de telessaúde desenvolvidas pelo Programa Saúde na Floresta em comunidades de áreas de conservação, no estado do Amazonas, durante a pandemia de COVID-19. Métodos: Trata-se de um relato de experiência sobre a criação e implementação do programa. Resultados: O projeto teve início em junho de 2021 com atendimentos na área de medicina e enfermagem e atualmente conta com 63 pontos de conectividade instalados. A dermatologia foi a especialidade mais requerida (30,1%), com as dermatites sendo o principal agravo diagnosticado. Para a enfermagem, a especialidade mais solicitada foi na área de obstetrícia, seguida pela pediatria. Rio Madeira e a Reserva extrativista Catuá-Ipixema solicitaram mais da metade de todos os atendimentos. Conclusão: Este projeto mostrou uma atuação diferenciada da telessaúde em comunidades ribeirinhas do Amazonas, especialmente no contexto pandêmico, ampliando o cuidado à saúde em áreas remotas, como estas em questão.

Conhecimento e prática universitária no uso de imagens de pacientes / Knowledge of the use of patient images at the university / Conocimiento y práctica universitaria en el uso de imágenes de pacientes

Resumo O uso de tecnologias da informação e comunicação na área da saúde tem crescido paralelamente ao avanço tecnológico. Por meio de pesquisa exploratória, descritiva, transversal e de abordagem quantitativa, objetivou-se identificar o conhecimento e a prática de discentes e docentes de universidade pública estadual sobre captação e reprodução de imagens de pacientes atendidos durante a prática acadêmica. Participaram do estudo 200 discentes matriculados nos cursos de odontologia, medicina e enfermagem, assim como 33 docentes que ministram alguma disciplina do ciclo profissional em qualquer dos referidos cursos. A pesquisa revelou preocupação com aspectos éticos e legais referentes a captura, armazenamento e disseminação de imagens clínicas de pacientes pelos profissionais e estudantes da saúde durante o processo de ensino e aprendizagem.

Abstract The use of information and communication technologies in the healthcare area has grown with technological advancements. Through an exploratory, descriptive, cross-sectional and quantitative approach, this study aimed to identify the knowledge and practice of students and professors of a public state university regarding the capture and reproduction of images from patients who have been attended by them. The research had the participation of 200 students enrolled in the dentistry, medicine and nursing courses, as well as 33 professors of these courses. The results show that they care about the ethical and legal aspects underlying the capture, handling, storage and dissemination of clinical images during the teaching and learning process.

Resumen El uso de tecnologías de la información y la comunicación en el área de la salud viene creciendo en paralelo al avance de la tecnología. Por medio de una investigación exploratoria, descriptiva, transversal y de abordaje cuantitativo, se pretendió identificar el conocimiento y la práctica de discentes y docentes de una universidad pública sobre la captación y la reproducción de imágenes de pacientes atendidos durante la práctica académica. Participaron en el estudio 200 discentes matriculados en las carreras de odontología, medicina y enfermería, así como 33 docentes que impartían alguna asignatura del ciclo profesional en cualquiera de dichas carreras. La investigación reveló una preocupación de los profesionales y estudiantes con los aspectos éticos y legales referentes a la captación, almacenamiento y divulgación de imágenes clínicas durante el proceso de enseñanza y aprendizaje.

Snakebites in Rio Branco and surrounding region, Acre, Western Brazilian Amazon

Abstract INTRODUCTION Snakebites are considered a neglected tropical disease in many countries in Latin America, including Brazil. As few studies have assessed snakebites in the Amazon region and especially in the state of Acre, epidemiological studies are of great importance. The present study aimed to describe the epidemiological characteristics of snakebites in the Rio Branco region, observing their characteristics in rural and urban areas and their correlation with rainfall and river outflow. METHODS This retrospective, descriptive study analyzed epidemiological information obtained from snakebite notifications registered on the Information System for Notifiable Diseases that occurred from March, 2018 to February, 2019. The cases of snakebite were correlated with rainfall and flow. RESULTS A total of 165 cases of snakebite were registered in the period. Most cases were caused by Bothrops and affected mainly individuals of the male sex who were between 21 and 30 years old. Most of the snakebites occurred in Rio Branco (71.52%; 29 cases per 100,000 inhabitants). Of these, 60.2% occurred in the urban area and 39.8% in the rural area and the majority occurred during the rainy season. CONCLUSIONS Although studies have shown that a majority of cases occur in rural areas, in this study, urbanization of snakebites was observed. The Bothrops genus was responsible for the highest number of snakebites and, during the rainy season, bites occurred more frequently. Educational prevention campaigns, population advice, and first aid in case of snakebites for the population are thus suggested.

Characterization of the rapid test for HIV/AIDS, syphilis and viral hepatitis in pregnant women / Retrato do teste rápido para HIV/AIDS, sífilis e hepatites virais em gestantes

The epidemiological and social importance of the vertical transmission mechanism for public health is indisputable,and as a strategy to guarantee the integrality of care, rapid testing has been decentralized to basic care. Therefore, thisstudy aimed to identify the sociodemographic and behavioral characteristics of the pregnant women tested for HIV/AIDS,syphilis, hepatitis B and C in Manaus, in the year 2014. It was carried out from secondary data in health units registeredand qualified to perform rapid testing. A total of 2,186 female patient records were identified, of which 86.3% werepregnant and 13.7% were not pregnant. Of the 38 units registered and considered suitable, it was found that in 13(34.2%) the exam was not being collected. Regarding the sociodemographic characteristics, it was identified that 43.1%of pregnant women were between 21 and 40 years of age, 53.6% said they were married and/or in a stable union, and 1/3had between 8 and 11 years of education, 47.6% were brown. Regarding the behavioral aspects, 52.9% of the pregnantwomen became aware of the rapid test offered during prenatal consultations, 67.9% declared a sexual preference for men,and an inconsistent condom use with partnerships was predominantly mentioned. Of the 1,886 pregnant women whoperformed the rapid test, 12 (0.6%) had a positive result for syphilis; 18 (1.0%) for HIV/AIDS; 2 (0.1%) for hepatitis B and5 (0.3%) for hepatitis C. Thus, the rapid test offered at the time of the reception in the health unit should be highlighted as a strategy to reach a larger share of the assisted clientele

A importância epidemiológica e social do mecanismo de transmissão vertical para a saúde pública é indiscutível, e comoestratégia para garantir a integralidade do cuidado, a testagem rápida foi descentralizada para a atenção básica. Assim sendo,esta pesquisa objetivou identificar as características sociodemográficas e comportamentais das gestantes testadas para HIV/AIDS, sífilis, hepatite B e C em Manaus, no ano de 2014, sendo realizada a partir de dados secundários nas unidades desaúde cadastradas e habilitadas para realizar a testagem rápida. Foram identificadas 2.186 Fichas de Atendimento demulheres, sendo 86,3% gestantes e 13,7% não gestantes e, das 38 unidades cadastradas e consideradas aptas, constatou-seque em 13 (34,2%) o exame não estava sendo coletado. Com relação às características sociodemográficas, identificou-seque 43,1% das gestantes apresentavam faixa etária entre 21 e 40 anos, 53,6% afirmaram estar casadas e/ou em uniãoestável e 1/3 apresentavam de 8 a 11 anos de estudo, sendo 47,6% da cor parda. Já nos aspectos comportamentais,52,9% das gestantes tomaram conhecimento sobre a oferta do teste rápido durante as consultas de pré-natal, 67,9%declararam preferência sexual por homens, e, predominantemente, foi mencionado o uso inconstante do preservativo comas parcerias fixas e eventuais. Das 1.886 gestantes que realizaram o teste rápido, 12 (0,6%) obtiveram resultado positivopara sífilis; 18 (1,0%) para HIV/AIDS; 2 (0,1%) para hepatite B e 5 (0,3%) para hepatite C. Dessa forma, destaca-se comoestratégia que o teste rápido seja ofertado ainda no momento do acolhimento na unidade de saúde, alcançando, assim,uma parcela maior da clientela assistida

Delayed healthcare and secondary infections following freshwater stingray injuries: risk factors for a poorly understood health issue in the Amazon

Abstract INTRODUCTION This study aimed to describe the profile of freshwater stingray injuries in the State of Amazonas, Brazilian Amazon, and to identify the associated risk factors for secondary infections. METHODS This cross-sectional study used surveillance data from 2007 to 2014 to identify factors associated with secondary infections from stingray injuries. RESULTS A total of 476 freshwater stingray injuries were recorded, with an incidence rate of 1.7 cases/100,000 person/year. The majority of injuries were reported from rural areas (73.8%) and 26.1% were related to work activities. A total of 74.5% of patients received medical assistance within the first 3 hours of injury. Secondary infections and necrosis were observed in 8.9% and 3.8%, respectively. Work-related injuries [odds ratio (OR) 4.1, confidence interval (CI); 1.87-9.13] and >24 hours from a sting until receiving medical care (OR; 15.5, CI; 6.77-35.40) were independently associated with the risk of secondary bacterial infection. CONCLUSIONS: In this study, work-related injuries and >24 hours from being stung until receiving medical care were independently and significantly associated with the risk of secondary infection. The frequency of infection following sting injuries was 9%. The major factor associated with the risk of secondary bacterial infection was a time period of >24 hours from being stung until receiving medical care.

Implication of Tityus apiacas (Lourenco, 2002) in scorpion envenomations in the Southern Amazon border, Brazil

Abstract Herein, four cases of scorpion stings caused by Tityus apiacas recorded from the municipality of Apuí, in the southern region of the Brazilian Amazon, are described. Patients showed systemic clinical manifestations, described as unusual, involuntary, and generalized tingling and numbness, reported by patients as an electric shock sensation, lasting up to 24 hours after the sting. All patients described local pain and sensation, along with other clinical symptoms including local edema and erythema. Systemic manifestations were not life threatening. Antivenom therapy was administered to all patients, who were discharged without complaints.

Fatores associados ao óbito e à reposição volêmica em pacientes com trauma por lesões penetrantes / Factors associated with death or volume replacement in patients with trauma due to penetrating injuries

Objective: to evaluate the prognostic factors of volume replacement in patients with trauma due to penetrating injuries. Methods: retrospective cohort study whose data were obtained by analyzing medical records of 544 patients who were admitted to the emergency unit, victims of penetrating trauma. Results: among the victims, 282 (51.9%) suffered stab wound, 262 (48.2%) injury by firearms, 486 (89.3%) were male, 382 (70.2%) were aged between 14 and 30 years. Most who received volume greater than 2000ml, systolic blood pressure ≤90mmHg and mean arterial pressure ≤65mmHg presented more mortality, with p <0.05, p <0.002 and p <0.003, respectively. Conclusion: the limited volume replacement can help in the good prognosis of victims of penetrating trauma.

Avaliar os fatores prognósticos da reposição volêmica em pacientes com trauma por lesões penetrantes. Métodos: estudo de coorte retrospectiva cujos dados foram obtidos através da análise de prontuários de 544 pacientes que deram entrada no serviço de emergência, vítimas de traumatismo penetrante. Resultados: dentre as vítimas, 282 (51,9%) sofreram ferimento por arma branca, 262 (48,2%) ferimento por arma de fogo, 486 (89,3%) eram do sexo masculino, com idade entre 14 e 30 anos 382 (70,2%). A maioria que recebeu fluído maior que 2000ml, pressão arterial sistólica ≤90mmHg e pressão arterial média ≤65mmHg, apresentou mais mortalidade, com valor de p<0,05, p<0,002 e p<0,003, respectivamente. Conclusão: a reposição volêmica limitada pode auxiliar no bom prognóstico do paciente vítima de trauma penetrante.

Hallux amputation after a freshwater stingray injury in the Brazilian Amazon

Abstract: Freshwater stingray injuries are a common problem in the Brazilian Amazon, affecting mostly riverine and indigenous populations. These injuries cause severe local and regional pain, swelling and erythema, as well as complications, such as local necrosis and bacterial infection. Herein, we report a case of bacterial infection and hallux necrosis, after a freshwater stingray injury in the Brazilian Amazon, which eventually required amputation. Different antimicrobial regimens were administered at different stages of the disease; however, avoiding amputation through effective treatment was not achieved.