ABSTRACT
OBJECTIVE: To compare the efficacy and safety of three polyspecific antivenoms for bites by pit vipers. DESIGN: Randomised double blind comparative trial of three antivenoms. SETTING: Shell, Pastaza, southeastern Ecuador. PARTICIPANTS: 210 patients with incoagulable blood were recruited from 221 consecutive patients admitted with snake bite between January 1997 and December 2001. INTERVENTION: One of three antivenoms manufactured in Brazil, Colombia, and Ecuador, chosen for their preclinical potency against Ecuadorian venoms. MAIN OUTCOME MEASURES: Permanent restoration of blood coagulability after 6 and 24 hours. RESULTS: The snakes responsible for the bites were identified in 187 cases: 109 patients (58%) were bitten by Bothrops atrox, 68 (36%) by B bilineatus, and 10 (5%) by B taeniatus, B brazili, or Lachesis muta. Eighty seven patients (41%) received Colombian antivenom, 82 (39%) received Brazilian antivenom, but only 41 (20%) received Ecuadorian antivenom because the supply was exhausted. Two patients died, and 10 developed local necrosis. All antivenoms achieved the primary end point of permanently restoring blood coagulability by 6 or 24 hours after the start of treatment in > 40% of patients. Colombian antivenom, however, was the most effective after initial doses of 20 ml (two vials), < 70 ml, and any initial dose at both 6 and 24 hours. An initial dose of 20 ml of Colombian antivenom permanently restored blood coagulability in 64% (46/72) of patients after 6 hours (P = 0.054 compared with the other two antivenoms) and an initial dose of < 70 ml was effective at 6 hours (65%, P = 0.045) and 24 hours (99%, P = 0.06). Early anaphylactoid reactions were common (53%, 73%, and 19%, respectively, for Brazilian, Colombian, and Ecuadorian antivenoms, P < 0.0001) but only three reactions were severe and none was fatal. CONCLUSIONS: All three antivenoms can be recommended for the treatment of snakebites in this region, though the reactogenicity of Brazilian and Colombian antivenoms is a cause for concern.
Subject(s)
Antivenins/therapeutic use , Crotalid Venoms , Crotalus , Snake Bites/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Animals , Antivenins/adverse effects , Antivenins/blood , Brazil , Child , Child, Preschool , Colombia , Double-Blind Method , Ecuador , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
BACKGROUND: Each year, around 50,000 women die from preeclampsia-eclampsia worldwide. Thus, hypertensive disorders during pregnancy are public health problems in both developed and developing countries. OBJECTIVE: To identify prognosis factors associated with HELLP syndrome in patients with severe preeclampsia. MATERIAL AND METHODS: A retrospective, observational, cross-sectional, and analytical study was carried out. It included patients that suffered from severe preeclampsia, with and without HELLP syndrome. They were hospitalized at the Division of Obstetrics Dr. Manuel Gea González General Hospital, from January 1st, 1995 to January 1st, 2000 (study group). Only clinical files of patients with severe preeclampsia, without convulsions, HELLP syndrome, or who had not died during the days spent at the hospital were included in the control group; within at least 72 subsequent hours to the pregnancy termination. The connection of HELLP syndrome with the following variables was assessed in the control group: gestational age, maternal age, infant formula, prenatal control, hypertensive disorder history, headache, tinnitus, phosphen, nausea, vomiting, epigastric pain, edema, hyperreflexia, blood pressure values, hepatic biometry, platelet count, blood chemistry with hepatic function. RESULTS: Right upper quadrant or epigastric pain was the most important independent prognosis factor. There were significant differences in the admission laboratory values between those with HELLP syndrome and those without acute complications of preeclampsia. CONCLUSIONS: Although the contribution of right upper quadrant or epigastric pain to the risk status of a pregnant patient is difficult to quantify, it can be used to assess whether the patient is at high risk for development of HELLP syndrome.