Análise epidemiológica dos acidentes por animais peçonhentos no estado de pernambuco / Epidemiological analysis of accidents caused by venomous animals in the state of Pernambuco

Objetivo: Analisar o perfil epidemiológico dos acidentes por animais peçonhentos no estado de Pernambuco, entre 2018 e 2022. Método: Pesquisa epidemiológica do tipo quantitativa, realizada com secundários do SINAN. Selecionado às variáveis: sexo, faixa etária, raça, escolaridade, gestação, local de picada, tempo de atendimento, tipo de acidente, soroterapia, classificação e evolução final. Os Programa Microsoft Excel e Word foram utilizados para análise estatística. Resultados: Foram notificados 105.005 casos, predominando-se em períodos quentes e chuvosos. Houve maior notificação no sexo feminino (53,05%), dos 20 aos 39 anos (31,74%), ensino fundamental incompleto (15,96%), pardos (67,88%) e não gestantes (87,07%). A maioria dos acidentes foram causados por escorpiões (73,39%), originando-se nos pés (30,35%), com atendimento médico em até 1 hora (47,74%), leves (85,73%), evoluindo para cura (91,52%) sem soroterapia (82,92%). Conclusão: Torna-se evidente a importância de medidas para seu controle, principalmente em orientações populacional e o preenchimento correto da ficha de notificação.(AU)

To analyze the epidemiological profile of accidents by venomous animals in the state of Pernambuco between 2018 and 2022. Method: Quantitative epidemiological research using secondary data from SINAN. The following variables were selected: gender, age group, race, schooling, pregnancy, place of bite, time of care, type of accident, serotherapy, classification and final evolution. The Microsoft Excel and Word programs were used for statistical analysis. Results: 105,005 cases were reported, predominantly during hot and rainy periods. Most cases were reported among females (53.05%), those aged between 20 and 39 (31.74%), those with incomplete primary education (15.96%), those with brown skin (67.88%) and those who were not pregnant (87.07%). The majority of accidents were caused by scorpions (73.39%), originated in the feet (30.35%), with medical attention within 1 hour (47.74%), mild (85.73%), evolving to cure (91.52%) without serotherapy (82.92%). Conclusion: The importance of measures to control the disease is clear, especially in terms of guidance for the population and the correct completion of the notification form.(AU)

Analizar el perfil epidemiológico de los accidentes por animales venenosos en el estado de Pernambuco entre 2018 y 2022. Método: Investigación epidemiológica cuantitativa utilizando datos secundarios del SINAN. Fueron seleccionadas las siguientes variables: sexo, grupo de edad, raza, escolaridad, embarazo, lugar de la mordedura, tiempo de atención, tipo de accidente, sueroterapia, clasificación y evolución final. Para el análisis estadístico se utilizó Microsoft Excel y Word. Resultados: Se notificaron 105.005 casos, predominantemente durante los períodos cálidos y lluviosos. La mayoría de los casos se notificaron en mujeres (53,05%), con edades comprendidas entre 20 y 39 años (31,74%), con estudios primarios incompletos (15,96%), de piel morena (67,88%) y no embarazadas (87,07%). La mayoría de los accidentes fueron causados por escorpiones (73,39%), se originaron en los pies (30,35%), recibieron atención médica en menos de 1 hora (47,74%), fueron leves (85,73%) y evolucionaron hacia la curación (91,52%) sin sueroterapia (82,92%). Conclusión: Es evidente la importancia de las medidas de control de la enfermedad, especialmente en lo que se refiere a la orientación de la población y a la correcta cumplimentación del formulario de notificación.(AU)

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.

Animais peçonhentos e sua trajetória secular para as ações de saúde: do histórico à aplicação / Venomous animals and their secular trajectory for health actions: from history to application / Los animales venenosos y su trayectoria secular para las acciones de salud: de la historia a la aplicación

O livro Os animais peçonhentos na saúde pública expõe um vasto histórico de acidentes envolvendo problemas de saúde provocados por animais peçonhentos. Os autores resgatam trabalhos e vivências, descritos por Louis Pasteur e Vital Brazil, fundamentais para o desenvolvimento de processos da ciência translacional como compreendida hoje, no século XXI. A obra é marcada pela defesa da necessidade de políticas públicas coerentes que sejam capazes de promover ações de capacitação, prevenção, diagnóstico, tratamento e reabilitação dos pacientes.

The book Os animais peçonhentos na saúde pública presents a vast history of accidents involving health problems caused by venomous animals. The authors rescue works and experiences, described by Louis Pasteur and Vital Brazil, fundamental for the development of translational science processes as understood today, in the 21st century. The work is marked by the defense of the need for coherent public policies capable of promoting training, prevention, diagnosis, treatment and rehabilitation of patients.

El libro Os animais peçonhentos na saúde pública expone una vasta historia de accidentes que involucran problemas de salud causados por animals venenosos. Los autores rescatan obras y experiencias, descritas por Louis Pasteur y Vital Brazil, fundamentales para el desarrollo de los procesos de ciencia translacional tal como se entienden hoy, en el siglo XXI. El libro está marcado por la defensa de la necesidad de políticas públicas coherentes capaces de promover la formación, la prevención, el diagnóstico, el tratamiento y la rehabilitación de los pacientes.

Predictors of complications in venomous snakebites

Objectives: Factors responsible for causing complications in venomous snakebites are unknown. The present study was planned to identify such factors. Material and Methods: This was a prospective and observational study. All patients presenting to the emergency department between April 2016 and August 2017 with venomous snakebites and meeting inclusion/exclusion criteria were enrolled. Patients were divided into two groups based on the presence/absence of complications. Risk factors associated with complications were analyzed. Results: Out of 236 patients screened, 156 were eligible. Mean age was 39.5 ± 15.6; majority (n = 122, 78.2%) were in the age group of 20–59 years; 119 (76.3%) were males. Eighty-eight patients (56.4%) developed complications, of which, cellulitis/compartment syndrome (n = 54, 34.6%) was most common, followed by acute kidney injury (n = 18, 11.5%), coagulopathy/disseminated intravascular coagulation (n = 17, 10.9%), neuroparalysis needing ventilator (n = 12, 7.7%), shock (n = 8, 5.1%), acute respiratory distress syndrome (three patients, 1.9%), and sepsis (one patient, 0.6%). The mortality rate was 1.92%. On univariate analysis, low hemoglobin, elevated neutrophil count, lower lymphocyte count, serum creatinine, initial/total dose of anti-snake venom, and prolonged hospital stay had a statistically significant association with complications. On multivariate analysis, elevated neutrophil count (OR 1.084; 95% CI 0.997, 1.179) and prolonged hospital stay (OR 1.975; 95% CI 1.393, 2.800) were associated with complications. Bite-to-needle time was associated with mortality. Conclusion: The nature of complications depends on composition of venom, and thus varies with geographical region. The Association of neutrophil and lymphocyte counts points to an inflammatory hypothesis. The Association of bite-to-needle time with mortality highlights the early use of antivenom. Awareness of risk factors may guide in predicting complications.

Venomous animals in Pernambuco: children at risk / Animais peçonhentos em Pernambuco: crianças em risco

Abstract Objectives: to analyze the epidemiological and clinical aspects of accidents caused by venomous animals in children under 15 years old. Methods: a cross-sectional study with an analytical component using secondary data from Centro de Informação e Assistência Toxicológica de Pernambuco (CIATox-PE), (Poison Center in Pernambuco)), in 2017 to 2019. Notifications of accidents caused were included in the studied age group and evaluated the characteristics of poisoning (animal classification, exposure zone, place and time of the occurrence and specific use of serum therapy), and of the patient (sociodemographic variables, clinical condition and evolution). The analysis performed in STATA® 13.1 presents frequency distribution tables and Pearson's chi-square for comparison. Results: of the 2678 notifications, 82,8% were scorpionism and 10, 8% snakebite. The age group of1 to 9 years old (70.5%) and being male (54.1%) were predominant. Most of the cases occurred in urban area (80.9%), in Recife (67.3%), inside the victim's residence (83.9%) and at night (47.3%). The majority (87.1%) were classified as 'mild severity', 10% received antivenom therapy and one died (by scorpionism). Two cases of snakebite in the workplace were registered. Conclusion: there was a high frequency of accidents caused in the urban area, which may be related to the lack of urban planning and sanitary education. The accidents caused among children in the household environment and the suspicion of child labor in the age group of 10 to 14 years old were also highlighted which favors the development and habits of the venomous animal.

Resumo Objetivos: analisar aspectos epidemiológicos e clínicos dos acidentes por animais peçonhentos em menores de 15 anos. Métodos: estudo transversal com componente analítico utilizando dados secundários do Centro de Informação e Assistência Toxicológica de Pernambuco (CIATox-PE), no período de 2017 a 2019. Foram incluídas as notificações dos acidentes na faixa etária estudada e avaliadas características do envenenamento (classe do animal, zona de exposição, local/turno da ocorrência e uso soroterapia específica) e do paciente (variáveis sociodemográficas, gravidade clínica e evolução). A análise realizada no STATA® 13.1 apresenta tabelas de distribuição de frequência e qui-quadrado de Pearson para comparação. Resultados: das 2678 notificações, 82,8% foram de escorpionismo e 10,8% de ofidismo. Predominaram na faixa etária de 1a 9 anos (70,5%) e sexo masculino (54,1%);ocorreram principalmente na zona urbana (80,9%),no Recife(67,3%), na residência da vítima (83,9%), durante horário noturno (47,3%). A maioria (87,1%) foi classificada como de gravidade leve, 10% receberam soroterapia e ocorreu um óbito (escorpionismo). Registraram-se dois casos de ofidismo em ambiente de trabalho. Conclusão: ressaltam-se os acidentes intradomiciliares entre crianças e a suspeita de trabalho infantil na faixa etária de 10 a 14anos.Os acidentes ocorreram sobretudo na zona urbana provavelmente associado à falta de planejamento e educação sanitária que favorece o desenvolvimento e hábitos do animal peçonhento.

Acidentes e plantas hospedeiras associadas a lagartas urticantes / Accidents and host plants associated with urticant caterpillars / Accidentes y plantas hospedadoras asociadas a orugasurticantes

Introdução: Ambientes urbanos como áreas verdes, praças, parques e escolas estão se tornando cada vez mais propícios ao aparecimento de animais peçonhentos, dentre eles as lagartas urticantes. Acidentes com algumas lagartas urticantes podem ser graves, podendo leva ao óbito, como no caso do gênero Lonomia.Objetivo:descrever o perfil epidemiológico dos acidentes envolvendo lagartas urticantes no município de Chapecó, Santa Catarina e identificar espécies vegetais hospedeiras destas lagartas.Metodologia:Foram coletados os dados epidemiológicos dos acidentes com lagartas urticantes registrados no período entre 2016 e 2017. Os dados foram obtidos junto ao Sistema de Informação de Agravos de Notificação.Foram analisadas as variáveis sexo, idade, parte do corpo acometida, os meses que houve as notificações, a ocupação dos indivíduos que tiveram contato com a lagarta, local em que residem, escolaridade e a espécie da lagarta envolvida. Ainda, foram identificados os espécimes coletados pelo setor de Vigilância em Saúde Ambiental, bem como foram identificadas as plantas hospedeira sem que foram encontrados.Resultados:Foram registrados 377 acidentes envolvendo majoritariamente o sexo feminino e a faixa etária entre 20 a 49 anos.As partes do corpo mais acometidas foram o pé (17,0%), mão (12,9%) e cabeça (11,4%). Foram identificadas seis espécies de plantas associadas à ocorrência de lagartas urticantes Conclusões:O estudo contribui com informações epidemiológicas sobre os acidentes causados por lepidópteros em um município de grande porte. Ressalta-se, a importância de ampliar as pesquisas em relação às plantas hospedeiras e a divulgação dos resultados visando a prevenção de acidentes (AU).

Introduction:Urban environments such as green areas, squares, parks and schools are becoming more and more favorableto the appearance of venomous animals, including urticatingcaterpillars. Accidents with some stinging caterpillars can be serious and can lead to death, as in the case of the genus Lonomia. Objective:to describe the epidemiological profile of accidents involving stinging caterpillars in the municipality of Chapecó, Santa Catarina and to identify host plant species of these caterpillars. Methodology:Epidemiological data on stinging caterpillar accidents recorded in the period between 2016 and 2017were collected. The data were obtained from the Sistema de Informação de Agravos de Notificação. The variables sex, age, body part affected, the months of the notifications, the occupation of the individuals who had contact with the caterpillar, the place where they live, education and the species of the caterpillar involved were analyzed. Still, the specimens collected by the Environmental Health Surveillance sector were identified, as well as the host plants in which they were found. Results:There were 377 accidents involving mostly females and the age group between 20 and 49 years. The parts of the body most affected were the foot (17.0%), hand (12.9%) and head (11.4%). Six species of plants were identified associated with the occurrence of stinging caterpillars.Conclusions:The study contributes with epidemiological information on accidents caused by Lepidoptera in a large municipality. The importance of expanding research in relation to host plants and the dissemination of results aimed at preventing accidents are emphasized (AU).

Introducción: Los entornos urbanos como áreas verdes, plazas, parques y escuelas son cada vez más propicios para la aparición de animales venenosos, incluidas las orugas urticantes. Los accidentes con algunas orugas pueden ser graves y provocar la muerte, como en el caso del género Lonomia.Objetivo: describir el perfil epidemiológico de los accidentes por orugasurticantes en el municipio de Chapecó, Santa Catarina e identificar especies de plantas hospedadoras de estas orugas.Metodología: Se recolectaron datos epidemiológicos sobre accidentes de orugas urticantes registrados en el período entre 2016 y 2017. Los datos se obtuvieron del Sistema de Informação de Agravos de Notificação(SINAN). Se analizaron las variables sexo, edad, parte del cuerpo afectada, los meses delas notificaciones, la ocupación de los individuos que tuvieron contacto con lasorugas, el lugar donde viven, educación y la especie de oruga involucrada. Aún así, se identificaron los especímenes recolectados por el sector de Vigilancia de Salud Ambiental, así como las plantas hospedantes en las que se encontraron.Resultados: Se produjeron 377 accidentes que afectaron en su mayoría a mujeres y al grupo de edad entre 20 y 49 años. Las partes del cuerpo más afectadas fueron el pie (17,0%), mano (12,9%) y cabeza (11,4%).Se identificaron seis especies de plantas asociadas con la ocurrencia de orugas urticantes.Conclusiones: El estudio presentainformación epidemiológica sobre accidentes causados por lepidópteros en un municipio de gran tamaño. Se destacala importancia de ampliar la investigación en relación con las plantas hospedantes y la difusión de resultados orientados a la prevención delosaccidentes (AU).

Anti-Snake Venom Properties of Medicinal Plants: A Comprehensive Systematic Review of Literature

Abstract Snakebite is one of the major health issues posing considerable morbidity and mortality. According to an estimate of World Health Organization (WHO) (World health organization, 2021) approximately 5 million people are bitten by several species of snakes resulting in up to 2.5 million envenomation cases annually. The mainstay of treatment for envenomation is intravenous administration of anti-snake venom. Although antivenom neutralizes the systemic effects but it does not relieve the symptoms such as venom-induced hemorrhage, necrosis and nephrotoxicity. Moreover, the use of antivenoms is associated with hypersensitivity reactions including urticaria, anaphylaxis, or serum sickness due to their heterologous property. Furthermore, stringent storage conditions and narrow specificity of antivenoms limit their use in both developed as well as developing countries. In this context, researchers have been searching for natural products and plant extracts to explore their antivenom activity along with anti-myotoxic, anti-hemorrhagic and anti-inflammatory properties. Plant remedies may prove to be an effective alternate for antivenom sera with less adverse events and better tolerability. To the best of our knowledge, this is the first comprehensive review of medicinal plants possessing anti-snake venom activities against certain species of snakes. The current review highlights the investigated plants with their phytochemical analysis to integrate the available information for future research and development of antivenom sera.

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.

Epidemiological analysis of 952 venomous snake bite in Wuzhou City of Guangxi Zhuang Autonomous Region / 中华危重病急救医学

Objective:To improve the prevention and treatment of venomous snake bites by analyzing the epidemiological characteristics of venomous snake bite in Wuzhou City, Guangxi Zhuang Autonomous Region.Methods:A retrospective analysis was conducted. The medical records of 1 091 patients with venomous snake bites admitted to the department of snake wound of Wuzhou Hospital of Traditional Chinese Medicine from January 2014 to December 2020 were collected, including snake species, gender and age of patients, bite time, bite site and local symptom.Results:The medical records of 952 patients with a definite clinical diagnosis of snake bite were enrolled. Among the 952 patients with venomous snake bites, the main bites were from Ovophis (32.98%), Trimeresurus (27.84%) and Naja (26.26%), followed by Bungarus multicinctus (6.51%), Ophiophagus Hannah (3.15%) and Agkistrodonhalys (1.58%), and few bites were from Rhabdophis subminiatus (0.73%), Bungarus fasciatus (0.42%), viper (0.32%) and Agkistrodon (0.21%). Of the 952 patients with venomous snake bites, there were almost twice as many males as females [647 cases (67.96%) vs. 305 cases (32.04%), with male to female ratio of 2.12∶1]. The age of patients ranged from 0.8 to 87.0 years old, with 40-59 years old as the majority (42.44%), followed by ≥ 60 years old (27.31%). Snake bites mainly occurred from April to November (93.59%), with a peak in October (16.39%). The incidence time was mainly afternoon (12:00-17:59, 30.88%) and evening (18:00-23:59, 33.30%), followed by morning (06:00-11:59, 24.69%), and early in the morning (00:00-05:59, 11.13%). The incidence time of Ovophis and Bungarus multicinctus mainly concentrated in 18:00-23:59, the time of Trimeresurus was in 06:00-11:59, and that of Naja and Ophiophagus hannah was in 12:00-17:59. Most cases of snake bite were on limbs (98.53%), and mainly on the right limbs (53.57%). The lower limbs mainly were bitten by Ovophis, while the upper limbs mainly were bitten by Naja and by Ophiophagus hannah. The local symptoms of the bite of Ovophis and Trimeresurus were similar, mainly including pain, swelling, tenderness, high temperature of skin around the wound, bleeding and exudation, etc. And the local symptoms of the bite of Naja were pain, swelling, bruising, tenderness, bleeding and exudation, red skin, etc. Numbness and mild pain were the main symptoms of the bite of Bungarus multicinctus and Bungarus fasciatus, but other local characteristics were not obvious.Conclusions:The majority of venomous snake bite patients in Wuzhou City of Guangxi were middle-aged and elderly males, and the majority of venomous snakes were Ovophis, Trimeresurus, and Naja. Most venomous snake bite occurs from April to November, and the incidence time was concentrated between 12:00 and 23:59. The majority of venomous snake bite was limb bites. The local symptoms were pain, swelling, tenderness, high temperature of skin around the wound, bruising, etc. To reduce the incidence rate, disability rate and mortality of snake bite disease, a snake bite prevention system should be established, the education and publicity of snake bite prevention knowledge should be strengthened, the awareness of snake bite prevention should be improved, and clinical diagnosis and treatment should be assisted, based on the epidemiological characteristics of snake bite in Wuzhou area.

Epidemiological and clinical aspects of snakebites in the upper Juruá River region, western Brazilian Amazonia

This study addresses the clinical and epidemiological aspects of envenoming cases resulting from snakebites treated at a hospital in Cruzeiro do Sul, in the upper Juruá River region, western Brazilian Amazonia. The specific identity of snakes that caused the envenomings was inferred (a) from the diagnosis of patient symptoms and signs upon hospital admission, (b) by enzyme immunoassay for detection of Bothrops atrox and Lachesis muta venom from serum samples taken from patients before antivenom therapy, or (c) by direct identification of the snake, when it was brought along to the hospital or photographed. There were 133 snakebites (76.2 cases per 100,000 inhabitants) registered during one year (July 2017 to June 2018). Most snakebites (88.7%) were caused by Bothrops spp., and the rest by non-venomous snakes or dry bites. Snakebites tended to occur more often during the rainy season, coinciding with the period of greater reproductive activity of the snakes and greater availability of their prey. In addition, the increase in the water level of rivers and lakes during the rainy season tends to concentrate snakes in dry places and, thus, to increase encounters with humans. Information campaigns on prevention and first aid, specially among the most vulnerable groups (indigenous people, farmers, and children and teenagers in rural areas), and the importance of using protective equipment (boots, leggings, leather gloves) in certain high risk activities (e.g. agriculture and extractivism in forests) are fundamental for the reduction of snakebite morbidity. (AU)

Hand perforation caused by a Gafftopsail catfish (bagre marinus) in a fisherman from Northeastern Brazil / Perfuração da mão por bagre branco (bagre marinus) em pescador do nordeste do Brasil

A 39-year-old male fisherman from Ceará State in Northeastern Brazil presented to the emergency room complaining of intense pain, edema, and bleeding in his left hand (Figure 1A-1B), He had a recent history of traumatism with hand perforation caused by the stinger of a gafftopsail catfish (Bagre marinus) (Figure 2A-2C). The injury occurred 4 hours prior when pulling his fishnet in the ocean. Right after the injury, the patient presented local pain and classified as eight in a visual analogue scale of pain. He denied systemic symptoms such as fever. On physical examination, he presented with two perforations separated by about 2 cm with slight bleeding (Figure 1A), local edema, and pain in his left hand (Figure 1B). Local cleansing of the lesion was performed. He was advised to apply warm compresses and used analgesics/anti-inflammatory drugs with the improvement of the inflammation. Systemic antibiotics were not necessary.

Um pescador de 39 anos, natural do Ceará, na região Nordeste do Brasil, deu entrada na emergência com queixa de dor intensa, edema e sangramento no dorso da mão esquerda (figura 1A-1B). Ele apresentava história recente de trauma na mão por ferrão de bagre branco (bagre marinus). A lesão ocorreu durante o ato de puxar a rede do oceano, quatro horas antes do atendimento. Logo após a lesão, apresentou dor intensa, nota 8 na escala visual analógica de dor. Ele negou sintomas sistêmicos, como febre. No exame físico, apresentava duas perfurações separadas por cerca de 2 cm com leve sangramento (figura 1A), edema e dor na mão esquerda (figura 1B). Foi realizada limpeza da lesão. Alem disso, foi orientado a aplicar compressas mornas e fazer uso de analgésicos /anti-inflamatórios para a melhora da inflamação. Antibióticos sistêmicos não foram necessários.

Health-risk assessment of Portuguese man-of-war (Physalia physalis) envenomations on urban beaches in São Luís city, in the state of Maranhão, Brazil

Abstract INTRODUCTION: The Portuguese man-of-war (Physalia physalis) is a cosmopolitan species, with a widespread distribution and responsible for a great number of injuries caused by cnidarians worldwide, including Brazil. Geoprocessing technology, however, has never been used to assess the spatial distribution of these animals on beaches. The aim of this study was to carry out a health risk assessment of Portuguese man-of-war (P. physalis) envenomations on the São Marcos and Calhau beaches in São Luís city, in the state of Maranhão, Brazil. METHODS: This is a descriptive and quantitative study concerning primary data on the occurrence of the Portuguese man-of-war (P. physalis) and human envenomations in the studied places, conducted over a two-year period in São Luís, Maranhão, northeastern Brazil. RESULTS: Envenomations mainly occurred on beaches presenting high density of P. physalis during the dry period. Vinegar has been incorporated as a first aid, according to recommendations set by the Brazilian Ministry of Health. CONCLUSIONS: In order to improve prevention and control actions of human envenomation, risk areas for this type of envenomation should be clearly indicated as alert areas. Inclusion of the geographical location of the envenomation in the Notification/Investigation SINAN Form was suggested for allowing the continuity of studies involving this public health issue.

Injuries caused by fish to fishermen in the Vale do Alto Juruá, Western Brazilian Amazon

Abstract INTRODUCTION: This study aimed to document injuries caused by fish among professional fishermen in the Western Brazilian Amazon. METHODS: We undertook a descriptive, retrospective study, involving 51 professional fishermen, to determine clinical, epidemiological, and therapeutic aspects of their injuries. RESULTS: Among 51 fishermen interviewed, most injuries were due to mandi (Pimelodus spp.), and the hands were the most injured region, resulting in pain and bleeding in all cases. CONCLUSIONS: Our study findings confirm the morbidity of fish-related injuries, and reaffirm the need for relevant information regarding prevention and injury management.

Epidemiology of the injury with venomous animals in the state of Rio Grande do Norte, Northeast of Brazil / Epidemiologia dos acidentes com animais peçonhentos no estado do Rio Grande do Norte, Nordeste do Brasil

Abstract This report is an investigation of the epidemiological features of injuries with venomous animals in the Rio Grande do Norte state, Northeastern Brazil, from 2007 to 2014. A total of 30,429 cases were analyzed. Cases were distributed over all months of the period studied and occurred mainly in urban areas. Scorpion stings showed the highest percentage of cases, but the chance of death among snakebites was higher. Envenomation predominated in females with age between 20 and 49 years old. Children and elderly showed a higher chance of death. Most victims were bitten on the extremities of the limbs and received medical care within 0-1 hour after being bitten. The main local and systemic symptoms reported were pain and headache, respectively. Cases were mostly classified as mild and progressed to cure. Few victims show local and systemic complications. The high number of accidents with venomous animals shows that Rio Grande do Norte may be an important risk area for such injuries. Furthermore, this study provides data for the development of health actions to promote control and prevention of these injuries in this region.

Resumo Este estudo é uma investigação das características epidemiológicas dos acidentes com animais peçonhentos no estado do Rio Grande do Norte, Nordeste do Brasil, de 2007 a 2014. Um total de 30.429 casos foram analisados. Os casos foram distribuídos em todos os meses do período estudado e ocorreram principalmente em áreas urbanas. Os acidentes escorpiônicos representaram maior percentual de casos, entretanto, a chance de morte entre acidentes ofídicos foi maior. Os envenenamentos predominaram em mulheres com idade entre 20 e 49 anos. Crianças e idosos exibiram maiores chances de morte. A maioria das vítimas foi picada nas extremidades dos membros e recebeu assistência médica entre 0-1 hora após o incidente. Os principais sintomas locais e sistêmicos reportados foram dor e cefaléia, respectivamente. Os casos foram principalmente classificados como leves e progrediram para cura. Poucas vítimas manifestaram complicações locais e sistêmicas. O elevado número de acidentes com animais peçonhentos indica que o estado do Rio Grande do Norte pode ser uma importante área de risco para tais acidentes. Além disso, este estudo fornece dados que poderão ser utilizados para a elaboração de ações em saúde, a fim de promover o controle e a prevenção desses acidentes nesta região.

Ophidian envenomings in a region of Brazilian Western Amazon / Envenenamentos ofídicos em uma região da Amazônia Ocidental Brasileira

INTRODUCTION: Snakebites are a public health problem and are considered clinical emergencies, what makes studies in high-incidence regions very importantOBJECTIVE: To describe the clinical and epidemiological aspects of patients suffering from snakebite accidents in a region of the Western Amazon, BrazilMETHODS: It is a cross-sectional, retrospective and documentary quantitative approach, from 2015 to 2016, held at the Regional Hospital of Juruá, located in the city of Cruzeiro do Sul, Acre, Brazil. Epidemiological data were obtained from the forms of the Notification Disease Information System (SINAN), in the Epidemiological Surveillance Sector of the hospital. The following variables were verified: month of occurrence, snake identification (type of accident), accident location (urban and rural), locality, municipality, victim data (age group, sex, anatomical region affected), symptoms and signs circumstances of the accident, time elapsed between accident and care, number of ampoules used, and type of serumRESULTS: An average of 124 cases of snakebites were treated per year (76.71 cases per 100,000 inhabitants/year), most of them were botropic accidents and the patients were male adult and rural workers, bitten in the lower limbs. More than 30% of cases were treated six hours after poisoning and 24-hour care is a risk factor for complications, as seven of the eight patients who had complications were treated within one day of the accidentCONCLUSION: It was presented a constant increase in the cases, which generated a worrying point of reflection, which may be associated with two factors, where one turns to the improvement in the displacement of victims (improvements in branch roads and implementation of SAMU speedboat) facilitating plus transport and telephone coverage by improving communication, or the failure of public health policies to provide better conditions and guidance to the population

INTRODUÇÃO: Os acidentes ofídicos são um problema de saúde pública e são considerados emergências clínicas, motivo este que torna os estudos em regiões de grande incidência muito importantesOBJETIVO: Descrever os aspectos clínicos e epidemiológicos de pacientes vítimas de acidentes ofídicos em uma região da Amazônia Ocidental, BrasilMÉTODO: Trata-se de um transversal, retrospectivo e documental de abordagem quantitativa, no período de 2015 a 2016, realizado no Hospital Regional do Juruá, localizado na cidade de Cruzeiro do Sul, Acre, Brasil. Os dados epidemiológicos foram obtidos a partir das fichas do Sistema de Informação de Agravos de Notificação (SINAN), no Setor de Vigilância Epidemiológica do hospital. Foram verificadas as seguintes variáveis: mês de ocorrência, identificação da serpente (tipo de acidente), local do acidente (zona urbana e rural), localidade, município, dados da vítima (faixa etária, sexo, região anatômica atingida), sintomas e sinais apresentados, circunstâncias do acidente, tempo decorrido entre o acidente e o atendimento, a quantidade de ampolas utilizadas e o tipo de soro no tratamento das vítimasRESULTADOS: Foram atendidos em média 124 casos de acidentes ofídicos por ano (76,71 casos por 100.000 habitantes/ano), sendo a maioria acidentes botrópicos e os pacientes constituídos por indivíduos adultos do sexo masculino e trabalhadores rurais, picados nos membros inferiores. Mais de 30% dos casos foram atendidos seis horas após o envenenamento e o atendimento após 24 horas é um fator de risco para complicações, uma vez que sete dos oito pacientes que apresentaram complicações foram atendidos depois de um dia do acidenteCONCLUSÃO: Apresentou um crescente constante nos casos, o que gerou um ponto de reflexão preocupante, que pode estar associado a dois fatores, onde um volta-se para a melhora no deslocamento das vítimas (melhorias nas estradas dos ramais e implantação de lancha do SAMU) facilitando mais o transporte e na cobertura de telefonia melhorando a comunicação, ou a falha das políticas de saúde pública na oferta de melhores condições e orientações para a população

Accident and vascular injury with stingray in the Alto Juruá, Acre, Brazil: a case report / Acidente e lesão vascular com arraia no Alto Juruá, Acre, Brasil: um relato de caso

INTRODUCTION: Injuries caused by fish are common and considered a neglected health problem with high morbidity and low lethality. Noteworthy are the envenomings by freshwater stingrays, which are considered very serious and one of the most important injuries caused by aquatic animals in South America. CASE PRESENTATION: To describe an accident and vascular injury with venomous stingray animals in the Alto do Juruá, Acre, Brazil. Male patient admitted due to stingray in the left lower extremity 20 days ago. CONCLUSION: The freshwater stingray, due to its sharp characteristics, injured the great saphenous vein, requiring surgical intervention. The situation presented negative evolution due to the lack of necessary procedures in the first attendance, such as the proper cleaning of the wound and the removal of the sting.

INTRODUÇÃO: Acidentes com peixes, denominados de ictismo, são comuns e são considerados um problema de saúde negligenciado, de alta morbidade e baixa letalidade. Destacam-se os envenenamentos por arraias de água doce, pois são considerados muito graves e uma das mais importantes lesões causadas por animais aquáticos na América do Sul. APRESENTAÇÃO DO CASO: Descrever um acidente e lesão vascular com animais peçonhentos do tipo arraia no alto do Juruá, Acre, Brasil. Paciente do sexo masculino, admitido devido a ferroada de arraia no membro inferior esquerda há 20 dias. CONCLUSÃO: O ferrão da arraia de água doce por possuir características pontiagudas lesionou a veia safena magna, necessitando de uma intervenção cirúrgica. O quadro apresentou evolução negativa devido a não realização de procedimentos necessários no primeiro atendimento, como a limpeza adequada do ferimento e a retirada do ferrão.

Molecular phylogenetics of Black Cobra (Naja naja) in Pakistan

Background: Snakes are found on every continent in the world except Antarctica, and on smaller land masses. Being ecologically important, they also cause a large number of bites, leading to millions of deaths. Mitochondrial and nuclear gene sequences are being used to identify, characterize, and infer genetic biodiversity among different snake species. Furthermore, phylogenetics helps in inferring the relationships and evolutionary histories among these species. Black cobra is one of the four most venomous snakes in Pakistan. Four mitochondrial (ND4, Cytochrome b, 12S rRNA, and 16S rRNA) and four nuclear (C-mos, RAG-1, BDNF, and NT3) genes were used to trace diversity and infer the phylogenetic relationship of black cobra in Pakistan. Results: Almost similar phylogenies were obtained through maximum likelihood and Bayesian inference, showing two species of cobra in Pakistan, namely, black cobra (Naja naja) and brown cobra (Naja oxiana). All Naja species were divided into three clades: black cobra (N. naja) and brown cobra (N. oxiana) cladding with different species of Naja; N. naja (Pakistan) cladding with N. naja from Nepal; and N. oxiana showed close relationship with Naja kaouthia from Thailand and Naja siamensis from Thailand. Conclusion: It was confirmed genetically that there are two cobra species in Pakistan, i.e., black and brown cobras. This study will help in not only genetic conservation but also developing anti-venom against snake species.

Incidence & management practices of snakebite: A retrospective study at Sub-District Hospital, Dahanu, Maharashtra, India

This study was undertaken to know the incidence and management practices of snakebite envenomation at the First Referral Unit - Sub-District Hospital, Dahanu, Maharashtra, India. Retrospective analysis of snakebite case records (n=145) was carried out for one-year period (January to December 2014). The annual incidence of snakebite was 36 per 100,000 population with case fatality rate of 4.5 per cent. Venomous snakebites were 76 per cent and non-venomous snakebites were 24 per cent. Overall, snakebites were more common in males (52.4%) than females (47.6%). Majority of the snakebites (66%) were in the age group of 18-45 yr. Seasonal variation was observed with highest snakebites in monsoon (58%). Lower extremities were the most common site of bites (63%). Neurotoxic and vasculotoxic envenomation were reported in 19 and 27 per cent snakebite cases, respectively. Anti-snake venom (ASV) was administered at an average dose of 7.5±0.63 vials (range 2-40, median 6). There was no uniform protocol followed for ASV administration as per the National Snakebite Management Protocol of Government of India (2009).

Snakebites in the Municipality of Tarauacá, Acre, Western Brazilian Amazon / Acidentes ofídicos no Município de Tarauacá, Acre, Oeste da Amazônia brasileira

INTRODUCTION: Snakebites are a public health problem and are considered a common clinical emergency in several tropical countries, especially in rural and forested regions where these animals are more frequent. It is estimated that approximately 28,800 cases of snakebites per year occur in Brazil, with an average of 119 deaths, in which the north region has the highest rate of incidence. However, the accuracy of these data ends up being brought into question, since there are undoubtedly many cases of under-reporting and even cases that are not reported at all, due to logistical and geographical reasons or due to a lack of preparation as to the precise identification of the problem. OBJECTIVE: This study aimed to describe the epidemiological characteristics of the reported cases of snakebites victims in the municipality of Tarauacá (Acre), comparing the morbidity coefficient with other Amazonian regions, and to observe possible factors associated with the appearance of complications in these cases. METHODS: This is a retrospective descriptive study through the analysis of the clinical-epidemiological information found on the notification sheets of the Information System of Notification Diseases of victims of snakebites that occurred during the period between 2012 and 2016 in Tarauacá. RESULTS: We recorded 96 snakebite cases during the study period, with the majority (95.8%) classified as botropic, followed by laquetics (3.2%) and one by a non-venomous snake (1%). No deaths were recorded. Snakebites were more frequent in rural areas (87.5%), most being an occupational accident, and affected mainly adult male individuals in their lower limbs. Most cases occurred during the rainy season and had a positive correlation with rainfall. CONCLUSIONS: The morbidity coefficient registered in Tarauacá in 2016 (72.5 cases per 100,000 inhabitants) was higher than that recorded in the cities of Cruzeiro do Sul and Rio Branco and in the states of Acre and Amazonas. Although most patients receive antivenom within the first six hours, many victims do not receive appropriate hospital care until more than 24 hours after the envenoming, which is a factor associated with the appearance of complications.

INTRODUÇÃO: Os acidentes ofídicos constituem um problema de saúde pública, sendo considerada uma emergência clínica comum em vários países tropicais, principalmente em regiões de zona rural e florestadas, onde esses animais são mais frequentes. É estimado ocorrerem aproximadamente 28.800 casos anuais de acidentes ofídicos no Brasil, com uma média de 119 óbitos, no qual a região Norte apresenta a maior incidência. Todavia, a precisão desses dados acaba sendo questionada, pois devem ocorrer muitas subnotificações e mesmo não notificações por questões logísticas e geográficas ou decorrentes ao despreparo quanto à identificação precisa do agravo. OBJETIVO: Descrever características epidemiológicas dos casos notificados de vítimas de acidentes ofídicos no município de Tarauacá (Acre), comparando o coeficiente de morbidade com outras regiões amazônicas e observar possíveis fatores associados ao surgimento de complicações dos casos. MÉTODO: Trata-se de um estudo descritivo retrospectivo através da análise das informações clínico-epidemiológicas das fichas de notificação do Sistema de Informação de Agravos de Notificação de vítimas de acidentes ofídicos ocorridos durante o período de 2012 a 2016 em Tarauacá RESULTADOS: Foram registrados 96 casos durante o período de estudo, sendo a maioria (95,8%) classificada como botrópico, seguido de laquéticos (3,2%) e um por serpente não peçonhenta (1%). Nenhum óbito foi registrado. Os acidentes foram mais frequentes na área rural (87,5%), sendo um acidente ocupacional, acometendo principalmente indivíduos adultos do sexo masculino em seus membros inferiores. A maioria ocorreu durante a estação chuvosa e teve correlação positiva com a pluviosidade. CONCLUSÃO: O coeficiente de morbidade registrado em 2016 (72,5 casos por 100.000 habitantes) foi maior do que o registrado em Cruzeiro do Sul e Rio Branco e também para os estados do Acre e Amazonas. Apesar da maioria dos pacientes receber a soroterapia dentro das primeiras seis horas, muitos recebem o devido atendimento hospitalar após 24 horas decorrido o envenenamento, sendo um fator associado ao surgimento de complicações.

Clinicoepidemiology, clinical profile and outcome of venomous snake bite in children in Konaseema region of Andhra Pradesh, India

Background: Venomous snake bite is an acute medical emergency, and children are more quickly and severely affected than adult. Venomous snake bite is responsible for 28.5 deaths per 1000 snake bite death among 5-15years old children. Most of them used to be from rural India and is more common in school going children. But there is no study regarding clinic epidemiology and treatment outcome among pediatric age group in this part of Andhra Pradesh. This retrospective descriptive has been conducted to evaluate the clinic epidemiology, clinical presentation, complication and treatment outcome in snake bite in pediatric patients in our set up.Methods: Present study is a retrospective, descriptive study conducted in the department of paediatrics Konaseema institute of medical science Amalapuram Andhra Pradesh, between 2006 to September 2018. This study protocol is approved by the institutional ethics committee. All the clinical parameters like, age, sex, season of bite, time of bite, socio economic statue, region, site, common clinical presentation, complications, reaction to ASV outcome of treatment were obtained from patient's case record and was analysed.Results: In present study total 166 snake bite patient case records were evaluated, out of this 166 snake bite cases, 28 bites were by unknown snakes. Demographic profile of patient shows that out of 70 cases, 49 cases were in male child and 21 cases were in female child. Regarding clinical profile of the children with snake bite as mentioned in Table 3, local pain was present in (n=70) 100 % patients. Local blending was presenting symptom in 64.28 %(n=45) patients.Conclusions: From present study authors conclude that snake bite in children is more common among school going children, during monsoon and post monsoon, and in rural area. In our region vasculotoxic snake envanomation is more common and presented with cellulitis which required surgical intervention in most of circumstances. In neurotoxic envenomation some patient developed respiratory paralysis which required ventilatory support.