Virología molecular de la rabia: un enfoque clínico / Rabies molecular virology: a clinical approach

Introducción: La rabia es una enfermedad zoonótica asociada al virus RABV, el cual tiene características neurotrópicas. El virus se transmite por el contacto con saliva de animales infectados; la mordedura de un perro es la causa más común. Es un virus que causa la muerte de miles de personas cada año. Objetivo: Describir a profundidad los principios moleculares de la infección por rabia, así como su patogenia, diagnóstico y tratamiento. Métodos: Se realizó una búsqueda de bibliografía en PubMed, SciELO, Scopus, Researchgate; se consultaron 163 referencias y se seleccionaron 51 fuentes que contenían la información más relevante para cumplir con el objetivo del trabajo. Conclusión: Actualmente es posible entender de mejor manera los mecanismos de transmisión y propagación del virus en el organismo; existe nuevo conocimiento sobre los receptores involucrados, así como la función de estos en la replicación viral. Sin embargo, el objetivo de la erradicación de la rabia a corto plazo es complejo. La invasión de territorios selváticos vuelve a la rabia un posible patógeno reemergente; la vacunación de especies transmisoras es el medio ideal para conseguir el control de la enfermedad.

Introduction: Rabies is a zoonotic disease associated with the RABV virus, which has neurotropic characteristics. The virus is transmitted by contact with saliva from infected animals; a dog's bite is the most common cause. This virus causes the death of thousands of people every year. Objective: To describe in depth the molecular principles of rabies infection, as well as its pathogenesis, diagnosis and treatment. Methods: A literature search was conducted in PubMed, SciELO, Scopus, and Researchgate. A total of 163 references were consulted, and 51 sources containing the most relevant information were selected to fulfill the objective of the work. Conclusions: It is currently possible to better understand the mechanisms of transmission and spread of the virus in the organism; there is new knowledge about the receptors involved, as well as their function in viral replication. However, the goal of eradicating rabies in the short term is complex. The invasion of wild territories makes rabies a possible re-emerging pathogen; vaccination of transmitting species is the ideal means to achieve disease control.

Epidemiological profile of dog attacks to patients under 14 years old assisted at the pediatric referral emergency unit of a tertiary hospital in Campinas, Brazil.

Introduction: Accidents involving dog attacks are very common, which makes this type of accident a global public health issue. The estimates point to 20% of the victims of such accidents seeking care in health units, and half of them being children. In addition to acute injuries, dog attacks might result in fractures, infections, scars, and psychological traumas. This study aimed to describe the epidemiological profile of dog attacks to children under 14 years old assisted in a pediatric emergency service in Brazil. Methods: The database of the Information and Toxicological Assistance Center of Campinas was surveyed to identify cases of children under 14 years old assisted after a dog attack in a 9-years period. Demographic data, number and type of lesions, type of exposure, part of the body affected, dog origin and condition, and the accident location and cause were analyzed. The data were presented in a descriptive way, and the age groups were classified as follows: 0-3 years old, 4-6 years old, and 7-14 years old. The different age groups were compared one to another regarding the markers evaluated using the chi-square test and the Fisher's exact test. A 0.05 alpha was adopted in all analyses. Results: The number of children assisted in the study period totaled 1,012. The 7-14-year-old group was the most affected (n = 498; 49.2%), male patients were also majority (n = 660; 65.2%). Most injuries were found on the head/neck area (n = 378; 37.4%). However, the older the patients were, the higher the frequency of lesions on upper and lower limbs was, as well as attacks occurred in external environments, thus involving animals that could not be observed. A significant increase in accidents with provoked causes was observed in younger patients. Conclusion: Accidents involving dog attacks are more likely to happen among boys. Younger children run higher risks of becoming victims of these accidents inside homes, being attacked by pets, and showing a greater incidence of head and neck lesions. Older children present more injuries on their limbs, which are caused by dogs that cannot be observed.

Retrospective analysis of dog bites in Southern Italy / Análise retrospectiva de mordidas de cães no sul da Itália

Dog bite is one of the major public health problems involving people worldwide. Although, several studies have investigated this phenomenon in different countries, little information about the incidence of dog bite episodes in Italy is available. We analysed data about dog biting events between 2010 and 2019 provided by the CRIUV, the Regional Reference Centre for Veterinary Urban Hygiene in the largest city of Southern Italy, namely. Naples. We observed severe and profound inconsistencies in the data collection that reveal structural and significant weaknesses of the current data collection system. Given the multifactorial nature of dog bite, we highlight the need to improve the gathering of all the information related to the factors affecting the occurrence of biting episodes for an accurate assessment of the biting phenomenon.

A mordida de cães é um dos maiores problemas de saúde pública que envolve pessoas em todo o mundo. Embora vários estudos tenham investigado esse fenômeno em diferentes países, poucas informações sobre a incidência de episódios de mordidas por cães na Itália estão disponíveis. Analisamos dados sobre eventos de mordidas de cães entre 2010 e 2019 fornecidos pelo CRIUV, Centro de Referência Regional para Higiene Veterinária Urbana na maior cidade do sul da Itália, Nápoles. Observamos inconsistências graves e profundas na coleta de dados que revelam fragilidades estruturais e significativas do sistema de coleta de dados atual. Dada a natureza multifatorial da mordida canina, destaca-se a necessidade de melhorar a coleta de todas as informações relacionadas aos fatores que afetam a ocorrência de episódios de mordida para uma avaliação precisa deste fenômeno.

Morphometric analysis of bite mark patterns caused by domestic dogs ( Canis lupus familiaris ) using dental wax registers / Análisis de patrones de huellas de mordedura producidos por perros domésticos ( Canis lupus familiaris ) utilizando registros en cera dental

Dog bites are a known public health problem involving physical, mental and emotional traumas. From a forensic point of view, it has been stated that their morphological characters, and the intercanine and interincisive measurements, could allow a taxonomic and specific identification of the implicated animal. The aim of this study was to differentiate and identify the biological profile of a potential aggressor dog by analysing eight morphometric bite patterns belonging to three different dog breeds. The data obtained were analyzed following three categories: a) breeds; b) sexes among breeds; and c) sex within breed. Significant differences were detected among the variables (p≤ 0.05), but only the maximum maxillary intercanines width (MaxCW) allowed a breed differentiation. The other variables allowed a differentiation between two breeds or one breed over the others. The principal components analysis (PCA) allowed visualizing the degree of dispersion and relationship among the scores. It showed three well-defined and separated breed groups, and different degrees of dispersion within and among breeds. The most important variable for such a differentiation was MaxCW. When considering sex among breeds for males, it showed a statistically significant difference, but only the diastema located between the third left mandibular, incisive and the left mandibular canine (C-I-ManL) allowed breed differentiation. For females, only MaxCW allowed a differentiation among breeds. The multivariate analysis permitted with a 95 % confidence interval, a breed and sex differentiation. Besides, the PCA models allowed classifying, identifying, separating and graphically showing the relationship among the variables. This made it possible to differentiate between breeds and sexes. Due to the large range of dog breeds around the world, this multivariate analysis could also help determining the dog's weight and size, narrowing down towards an approximate number of offending dogs, focussing on a certain kind of dog breed, and pinpointing any suspect dog.

Las mordeduras de perros son un conocido problema de salud pública que involucra traumas físicos, mentales y emocionales. En la faz forense, se ha establecido que características morfológicas, así como las medidas intercanina e interincisiva, permitirían una identificación taxonómica y especifica del animal involucrado. El objetivo fue diferenciar e identificar el perfil biológico de un potencial perro agresor analizando ocho patrones morfológicos de mordeduras pertenecientes a tres diferentes razas caninas. Los datos fueron analizados considerando tres categorías: a) razas; b) sexo entre razas; y c) sexo en cada raza. Se observaron diferencias entre las variables (p≤0,05), pero sólo la distancia máxima entre caninos maxilares (MaxCW), permitió una diferenciación entre razas. Las otras variables permitieron una diferenciación entre dos razas o de una raza sobre las otras. El análisis de componentes principales (PCA) permitió visualizar el grado de dispersión y la relación entre las puntuaciones (dentro y entre razas). Se observaron tres grupos (razas) bien definidos y separados con diferentes grados de dispersión dentro y entre razas. La variable más importante para tal diferenciación fue la MaxCW. Al considerar sexo (machos) entre razas, se encontró diferencia estadísticamente significativa, pero sólo la medida del diastema localizado entre el tercer incisivo y canino izquierdo mandibulares (C-I-ManL) permitió la diferenciación entre razas. Para hembras, sólo la MaxCW permitió una diferenciación entre razas. El análisis multivariante permitió, con un intervalo de confianza del 95 %, diferenciar raza y sexo. El modelo PCA permitió además clasificar, identificar, separar y mostrar gráficamente la relación entre las variables. Esto posibilitó diferenciar entre razas y sexos. Debido a la gran variedad de razas de perros en el mundo, este análisis multivariado permitiría estimar peso y tamaño del animal, indicando un número aproximado de perros atacantes, centrándose en ciertos tipos de raza, y localizar a cualquier cánido sospechoso.

Experience in the management of acute wounds by dog bite in a hospital of third level of plastic and reconstructive surgery in Mexico.

BACKGROUND: Dog bite injuries represent an important public health problem, involving all levels of care. They can vary in severity, from superficial wounds (skin and subcutaneous tissue) to devitalization and tissue loss, with the presence of systemic infections, aestethic and functional sequels that require specialized treatment. OBJECTIVE: To describe and share the 7-year experience in the management of dog bite wounds in a plastic and reconstructive surgery referral center in Mexico. METHOD: A retrospective study was conducted where all patients with dog bite wounds that came to the plastic and reconstructive emergency department were enrolled from July 2010 to August 2017. The collected patient demographic characteristics included age, age group, and sex. The collected injury variables included anatomical location, wound characteristics, antibiotic therapy and therapeutic management. RESULTS: A total of 416 patients were enrolled, 63% of the dog bites occurred in children under 18 years of age. The majority of the wounds were found in an isolated anatomical region 88.2%. The most frequent location was the face in 61.3%. Of all the cases 74.3% were treated only with primary wound closure, 21.4% also required some reconstructive surgical procedure, 2.9% did not require wound closure, and 1.4% were hospitalized. All patients received prophylactic antibiotics. 2% reported infection after the management with primary wound closure. CONCLUSIONS: The right management of dog bite wounds in all the health care levels improve the patient prognosis. Complex dog bite wounds must be treated immediately by the plastic and reconstructive surgery department in second or third levels of healthcare. Most of the wounds can be managed by primary closure and other reconstructive techniques with confidence.

ANTECEDENTES: Las heridas por mordedura de perro constituyen un problema de salud pública creciente que involucra a todos los niveles de atención. Pueden variar en gravedad, desde heridas superficiales (piel y tejido subcutáneo) hasta desvitalización y pérdida de tejidos, con presencia de infecciones, complicaciones y secuelas estéticas y funcionales que requieren tratamiento especializado. OBJETIVO: Describir la experiencia de 7 años en el manejo de heridas por mordedura de perro y proponer un algoritmo de manejo en un centro de referencia en cirugía plástica y reconstructiva en México. MÉTODO: Se realizó un estudio retrospectivo en el que se incluyeron todos los registros de pacientes con heridas por mordedura de perro entre julio de 2010 y agosto de 2017. Las variables recabadas fueron edad, sexo, localización anatómica, características de la herida y manejo terapéutico. RESULTADOS: Se obtuvo un total de 416 pacientes. El 63% de las lesiones ocurrieron en menores de 18 años. La mayoría de las heridas (88.2%) fueron aisladas en una región anatómica. La localización más frecuente fue la cara (61.3%). De todos los casos, el 74.3% se resolvieron solo con cierre primario, el 21.4% requirió además algún proceso reconstructivo, el 2.9% no requirió cierre y el 1.4% de los pacientes fueron hospitalizados. Todos los pacientes recibieron antibióticos profilácticos. El 2% reportaron infección posterior al manejo con cierre primario. CONCLUSIONES: El correcto abordaje de las heridas por mordedura de perro en todos los niveles de atención mejora el pronóstico de los pacientes. Las heridas complejas deben ser manejadas inmediatamente en un centro de segundo o tercer nivel con cirugía plástica y reconstructiva. La mayoría de las heridas por mordedura de perro pueden ser reparadas con cierre primario y otras técnicas reconstructivas con seguridad.

Osteomielitis secundaria a Pasteurella canis / Osteomyelitis due to Pasteurella canis

Resumen Se comunica el caso de una paciente que sufrió mordedura de perro. Solicitó atención médica inmediatamente en donde realizaron asepsia y antisepsia de la herida para posteriormente tratar la lesión. A las 12 horas la paciente comenzó a mostrar cambios de la coloración, aumento de temperatura, volumen y dolor de severa intensidad, por lo que acudió a nuestro hospital para valoración. Se tomaron cultivos y se realizó resonancia magnética, que mostró datos compatibles con infección de tejidos blandos y osteomielitis. En los cultivos se aisló Pasteurella canis. Se dio tratamiento con antibióticos orales con lo que se logró un desenlace favorable. El género Pasteurella lo constituyen cocobacilos gramnegativos, inmóviles, anaerobios facultativos. La cepa más aislada es P. canis posterior a mordeduras de perro y P. multocida y P. septicum en mordeduras de gato. La manifestación más frecuente es celulitis en el sitio de mordedura o arañazo. El diagnóstico se establece mediante métodos microbiológicos. El tratamiento de elección es la penicilina.

Abstract This paper reports a case of osteomyelitis due to Pasteurella canis after a dog bite. The patient requested medical care immediately after the bite, there were performed asepsis and antisepsis of the wound to later close the injury. After 12 hours, the patient's wound started changing colour with increase in temperature, volume and severe pain, so patient went to our hospital for evaluation. Cultures were taken, and magnetic resonance imaging showed images related to soft tissue infection and osteomyelitis. In cultures, Pasteurella canis was isolated. Treatment was given with oral antibiotics, achieving a favourable outcome. The genus Pasteurella are gram-negative, immobile, anaerobic facultative coccobacilli. The most isolated strain is P. canis after dog bites, and P. multocida and P. septicum in cat bites. The most frequent manifestation is cellulitis at the site of a bite or scratch. The diagnosis is made by microbiological methods. The treatment of choice is penicillin.

Caracterización clínico-epidemiológica de mordeduras en personas mayores en la provincia de los Andes, región de Valparaíso, Chile / Clinical-epidemiological characterization of bites in the elderly in the Andes province, Valparaíso region, Chile

Introducción: las mordeduras constituyen un relevante problema de salud, con amplio espectro clínico, pudiendo causar la muerte. Existe escasa información del tema en personas mayores (PM). Método: análisis de base de datos realizada a partir de formularios de notificación de mordeduras de centros de salud y de Protocolos de Denuncia de Animal Mordedor en la provincia de Los Andes, Chile. Objetivo: caracterizar epidemiológicamente las mordeduras en personas mayores ocurridas en la provincia de Los Andes, V región,(2005-2007). Resultados: de los 2358 casos de mordeduras notificados, 234 casos ocurrieron en PM (9,92 por ciento del total de casos), con un promedio de edad de 70,09 ± 7,896 años (rango = 60-95 años). La tasa de mordeduras para PM fue de 657,1 por 100000 hbtes (2005), 745,8 por 100000 hbtes (2006) y 627,6 por 100000 hbtes (2007). De éstos, la mayoría se produjo en el sexo femenino (56,8 por ciento) (p 0,016). El animal mordedor más frecuente fue el perro (75,6 por ciento) en ambos sexos. La complicación más frecuente fue la herida (74,4 por ciento), seguida por enfermedad por arañazo de gato (2,1 por ciento) y fractura (1,3 por ciento). Hubo 1 caso de artritis y 1 de celulitis por mordedura de araña. Conclusiones: las mordeduras en personas mayores son causa de morbilidad importante. Es relevante mejorar los sistemas de registro y vigilancia, y las medidas de educación en la tenencia responsable de animales para lograr una disminución de casos. Se requieren más estudios para determinar otras complicaciones y consecuencias de mordeduras en PM no visualizadas en este estudio.(AU)

Introduction: bites are a relevant health problem, with a varied clinical spectrum, which can cause death. There is limited information about bites in old people (OP). Methods: database analysis made with bites notification forms by health centers and Animal Bites Reporting Protocols in the province of Los Andes, Chile. Objective: typify bites epidemiologically in old people in the province of Los Andes, V region (2005 to 2007). Objective: typify bites epidemiologically in elderly people in the province of Los Andes, V region (2005 to 2007). Results: 234 out of 2358 cases of reported bites occurred in OP (9.92 percent of all cases), with an average age of 70.09 ± 7.896 years (range = 60-95 years). The bite rate for OP was 657.1 per 100000 inhabitants (2005), 745.8 per 100000 inhabitants (2006) and 627.6 per 100000 inhabitants (2007). Of these, most of them occurred in females (56.8 percent) (p 0.016). The most frequent biting animal was the dog in both genders (75.6 percent). The most frequent complication was injury (74.4 percent), followed by cat scratch disease (2.1 percent) and fracture (1.3 percent). There was 1 case of arthritis and 1 case of cellulitis due to spider bite. The most frequent complication was the wound (74.4 percent), followed by cat's scratch disease (2.1 percent) and fracture (1.3 ). There was 1 case of arthritis and 1 case of cellulitis due to spider bite. Conclusions: bites in old people are a cause of relevant morbidity. It is relevant to improve the registration and surveillance systems, and the education measures in responsible animal tenure to achieve a reduction of of cases. More studies are required to determine other complications and consequences of bites in OP not visualized in this study.(AU)

Dog bite injury - alar repair with composite graft.

Dog bite injuries are an important emergency. Facial dog bites can lead to disfigurement and stigmatization. Dog owners themselves are the usual victims of facial dog bites. Early surgery provides best results. A 28-year-old male patient presented 1 year after he had been bitten on his nose by his own dog. The pronounced nasal disfigurement with nostril stenosis was treated by reconstruction using a free composite graft from the crus of the ipsilateral ear with good results. Delayed reconstruction can provide satisfying results.

Animal and human bite injuries: a 5-year retrospective study in a large urban public hospital in Venezuela.

INTRODUCTION: Animal bite injuries to the head and neck regions are an important public health problem. Most of these bites are from dogs. A 10-year retrospective study was undertaken to determine the prevalence of animal and human bites. MATERIALS AND METHODS: This retrospective study was done from January 2011 to December 2016 and included 387 patients with a mean age of 21.51 years. Data collection included age, sex, days of hospitalization, lesion type, and clinical management. RESULTS: Majority of patients were in age group of 21-29 years, followed by 31-55 years. Out of the total 281 patients, 42 patients (51.60%) were males and 34 patients (48.40%) were females. Mean hospital stay was 7.2 days with a minimum of 5 days and a maximum of 12 days. Surgical management included cleansing and primary closure of the wound. CONCLUSIONS: We concluded that the use of empiric antibiotic prophylaxis is essential for management of facial animal bite, and the antibiotic of first choice is amoxicillin-clavulanic acid. The aim of immediate surgical repair (< 6 h) is to avoid infections. The persistence of dog bite is public health problem in Venezuela.

Reconstrucción labial por mordedura canina en una anciana / Labial reconstruction due to a dog bite in an elderly woman

Se presenta el caso clínico de una anciana de 80 años de edad con antecedentes de demencia senil, quien acudió acompañada de sus hijos a la consulta de Emergencia del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres por presentar mordedura de un perro en la región labial. A la paciente se le realizó lavado de la herida, desbridamiento y profilaxis, seguidos de la confección de colgajos locales combinados y sutura inmediata. Los resultados cosméticos y funcionales fueron catalogados como favorables.

The case report of an 80 years elderly woman with history of Alzheimer´s is presented, who went along with her children to the Emergency Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital due to a dog bite in the labial region. The wound cleaning, debridement and prophylaxis was carried out to the patient, followed by making combined local flaps and immediate suture. The cosmetic and functional results were classified as favorable.

Retrospective Cohort Study to Assess the Risk of Rabies in Biting Dogs, 2013⁻2015, Republic of Haiti.

BACKGROUND: In canine rabies endemic countries the World Health Organization recommends post-exposure prophylaxis (PEP) be initiated immediately after exposure to an animal suspected to have rabies. Limited capacity in low and middle income countries to assess biting animals for rabies may result in the over prescription of rabies biologics. Few guidelines exist to determine the risk of whether a dog that has bitten someone is rabid. Given PEP cost and access limitations in many countries, accurate and timely assessment of dogs that have bitten people may reduce unwarranted PEP use and improve healthcare seeking behaviors. METHODS: Haiti's animal rabies surveillance program utilizes veterinary professionals to conduct rabies assessments on reported biting dogs and records characteristics of the dog, health outcomes, and laboratory results in a national database. Characteristics of rabid dogs were assessed through a retrospective cohort study of biting dogs investigated during the period from January 2013⁻December 2015. 1409 biting dogs were analyzed; 1361 dogs that were determined to not have rabies were compared to 48 laboratory-confirmed rabid dogs. Rate ratios, sensitivity, specificity, positive predictive values, negative predictive values, likelihood ratios, quarantine survival of biting dogs, and a risk matrix were developed. FINDINGS: The assessor's determination that the animal likely had rabies was the most significant predictive factor for a rabid dog (RR = 413.4, 95% CI 57.33⁻2985, Sn = 79.17, Sp = 91.92). Clinical factors significantly associated with rabid dogs included hypersalivation, paralysis, and lethargy (RR = 31.2, 19.7, 15.4, respectively). Rabid dogs were 23.2 times more likely to be found dead at the time of the investigation compared to case negative dogs (95% CI 14.0⁻38.6). Rabid dogs were also significantly more likely to lack a history of rabies vaccination or be unowned (RR = 10.3 95% CI 2.5⁻42.3 and RR = 4.5 95% CI 2.0⁻10.1, respectively). Rabid dogs were four times more likely to have bitten multiple people (RR = 4.0 95% CI 1.9⁻8.3). Most rabid dogs died or were killed before quarantine (75%) and all died by day 3 of quarantine, compared to <1% of quarantined case-negatives. The greatest risk of death was predicted to be for persons bitten on the head or neck from symptomatic dogs. Bites from dogs deemed healthy by veterinary assessors and which were available for quarantine presented less than a 0.05% risk of rabies death to the victim. CONCLUSIONS: Vaccination of all persons exposed to a suspected rabid dog is a highly effective approach to minimize human rabies deaths. However, this may place undue financial burden on bite victims that have had a low-risk exposure and over-prescription may contribute to regional supply shortages. The results here indicate that in a low-resource country such as Haiti, a well-trained veterinary assessor can provide an accurate risk assessment of biting dogs based on a standard case investigation protocol. In canine rabies endemic countries with limited access to PEP, or where PEP costs may cause undue burden on bite victims, structured risk assessments by trained professionals may be a reliable method of triaging PEP for bite victims. Evaluating rabies risk through a matrix of bite location and risk factor in the dog presents a clear delineation of high and low risk encounters and should be used to develop data-derived PEP recommendations.

Epidemiological characteristics of human rabies in Henan province in China from 2005 to 2013.

BACKGROUND: Rabies is very common in People's Republic of China. Henan province, in the central portion of China, is one of the most densely populated provinces in the entire country. With the new rabies epidemic trend noted in northern and western China, it is necessary to investigate the characteristics of human rabies in this area and control the disease. METHODS: We chose patients in hospital isolation in 18 municipalities in Henan province as the investigation subjects. Data were collected through systematic reporting from these hospitals, whereas a questionnaire was applied to the relatives of patients. RESULTS: A total of 1022 rabies cases were reported. The incidence of human rabies in Henan has increased rapidly since 2005, having peaked in 2007, and maintained a high level in the remaining years. The cases were found mainly in rural areas in the south and east of the province. Rabies was often noted in summer and with the highest number in August. Most cases were noted in males and often in farmers. The patients aged between 40 and 60 years accounted for 36.8 % of all the cases. The wound treatment rate (12.2 %) and vaccination rate (2.6 %) of rabies cases after exposure were relatively low, while the rabies immunoglobulin utilization rate was only 2.8 %. CONCLUSIONS: Rabies epidemic cases at the county level overall were increasing in Henan province during the period of 2005-2013; the epidemic has spread quickly. The data in this study imply that the disease could be better managed by more integrated surveillance across human health and veterinary sectors, improved education and better government policies.

Epidemiological characteristics of human rabies in Henan province in China from 2005 to 2013

Background Rabies is very common in Peoples Republic of China. Henan province, in the central portion of China, is one of the most densely populated provinces in the entire country. With the new rabies epidemic trend noted in northern and western China, it is necessary to investigate the characteristics of human rabies in this area and control the disease.Methods We chose patients in hospital isolation in 18 municipalities in Henan province as the investigation subjects. Data were collected through systematic reporting from these hospitals, whereas a questionnaire was applied to the relatives of patients.Results A total of 1022 rabies cases were reported. The incidence of human rabies in Henan has increased rapidly since 2005, having peaked in 2007, and maintained a high level in the remaining years. The cases were found mainly in rural areas in the south and east of the province. Rabies was often noted in summer and with the highest number in August. Most cases were noted in males and often in farmers. The patients aged between 40 and 60 years accounted for 36.8 % of all the cases. The wound treatment rate (12.2 %) and vaccination rate (2.6 %) of rabies cases after exposure were relatively low, while the rabies immunoglobulin utilization rate was only 2.8 %.Conclusions Rabies epidemic cases at the county level overall were increasing in Henan province during the period of 20052013; the epidemic has spread quickly. The data in this study imply that the disease could be better managed by more integrated surveillance across human health and veterinary sectors, improved education and better government policies.(AU)

Luxación radio-cubital distal expuesta por mordedura canina no asociada con fractura: Técnica quirúrgica reconstructiva mediante anclaje para sindesmosis e injerto tendinoso. Reporte de caso / Exposed distal radio-ulnar dislocation by dog bite: Reconstructive surgical technique using a soft tissue graft and a syndesmotic fixation implant. Case report

La función principal del antebrazo es la pronosupinación, la cual se logra en gran medida mediante la estabilidad y características biomecánicas de la articulación radio-cubital distal. Existen diversas técnicas quirúrgicas para el tratamiento de las luxaciones radio-cubitales distales aisladas o asociadas con fractura. Presentamos el caso de un paciente entrenador canino quien fue mordido a nivel de la muñeca y antebrazo distal acudiendo al Servicio de Urgencias en donde se diagnostica una luxación cubital distal con exposición músculo tendinosa. Debido al agente lesivo y las múltiples lesiones de partes blandas resultó imposible realizar las técnicas habituales de tratamiento. Se describe la técnica utilizada para el manejo de este paciente mediante la colocación de injerto tendinoso autólogo de gracilis, plasma rico en plaquetas y dos sistemas de anclaje para sindesmosis de tobillo. Se inmovilizó por seis semanas e inició rehabilitación subsecuente y valorándolo a las 12, 18 y 28 semanas mediante la escala de MAYO, DASH y PRWE encontrando un resultado bueno que implica la reincorporación a las actividades laborales y cotidianas del paciente con un mínimo dolor y limitación.

The main function of the forearm is the supination, which is achieved largely through the biomechanical characteristics and stability of the distal radio-ulnar joint. There are several surgical techniques for the treatment of distal radio-ulnar dislocations isolated or associated with a fracture. We report the case of a canine trainer who was bitten at the wrist and distal forearm that came to the emergency department in where distal ulnar dislocation with muscle tendon exposure was diagnosed. Due to the offending agent and multiple soft tissue injuries the treatment with standard techniques was impossible. We describe the technique of treatment of this patient by placing autologous gracilis tendon graft, platelet rich plasma and two anchoring systems for ankle syndesmosis. Immobilization was maintained for six weeks with a subsequent rehabilitation and posterior valuation at 12, 18 and 28 weeks by the scale of MAYO, PRWE and DASH and finding a good result which implies the return to work and daily activities of the patient with minimal pain and limitation.

[Exposed distal radio-ulnar dislocation by dog bite. Reconstructive surgical technique using a soft tissue graft and a syndesmotic fixation implant. Case report]. / Luxación radio-cubital distal expuesta por mordedura canina no asociada con fractura. Técnica quirúrgica reconstructiva mediante anclaje para sindesmosis e injerto tendinoso. Reporte de caso.

The main function of the forearm is the supination, which is achieved largely through the biomechanical characteristics and stability of the distal radio-ulnar joint. There are several surgical techniques for the treatment of distal radio-ulnar dislocations isolated or associated with a fracture. We report the case of a canine trainer who was bitten at the wrist and distal forearm that came to the emergency department in where distal ulnar dislocation with muscle tendon exposure was diagnosed. Due to the offending agent and multiple soft tissue injuries the treatment with standard techniques was impossible. We describe the technique of treatment of this patient by placing autologous gracilis tendon graft, platelet rich plasma and two anchoring systems for ankle syndesmosis. Immobilization was maintained for six weeks with a subsequent rehabilitation and posterior valuation at 12, 18 and 28 weeks by the scale of MAYO, PRWE and DASH and finding a good result which implies the return to work and daily activities of the patient with minimal pain and limitation.

La función principal del antebrazo es la pronosupinación, la cual se logra en gran medida mediante la estabilidad y características biomecánicas de la articulación radio-cubital distal. Existen diversas técnicas quirúrgicas para el tratamiento de las luxaciones radio-cubitales distales aisladas o asociadas con fractura. Presentamos el caso de un paciente entrenador canino quien fue mordido a nivel de la muñeca y antebrazo distal acudiendo al Servicio de Urgencias en donde se diagnostica una luxación cubital distal con exposición músculo tendinosa. Debido al agente lesivo y las múltiples lesiones de partes blandas resultó imposible realizar las técnicas habituales de tratamiento. Se describe la técnica utilizada para el manejo de este paciente mediante la colocación de injerto tendinoso autólogo de gracilis, plasma rico en plaquetas y dos sistemas de anclaje para sindesmosis de tobillo. Se inmovilizó por seis semanas e inició rehabilitación subsecuente y valorándolo a las 12, 18 y 28 semanas mediante la escala de MAYO, DASH y PRWE encontrando un resultado bueno que implica la reincorporación a las actividades laborales y cotidianas del paciente con un mínimo dolor y limitación.

Epidemiological characteristics of human rabies in Henan province in China from 2005 to 2013

Background Rabies is very common in Peoples Republic of China. Henan province, in the central portion of China, is one of the most densely populated provinces in the entire country. With the new rabies epidemic trend noted in northern and western China, it is necessary to investigate the characteristics of human rabies in this area and control the disease.Methods We chose patients in hospital isolation in 18 municipalities in Henan province as the investigation subjects. Data were collected through systematic reporting from these hospitals, whereas a questionnaire was applied to the relatives of patients.Results A total of 1022 rabies cases were reported. The incidence of human rabies in Henan has increased rapidly since 2005, having peaked in 2007, and maintained a high level in the remaining years. The cases were found mainly in rural areas in the south and east of the province. Rabies was often noted in summer and with the highest number in August. Most cases were noted in males and often in farmers. The patients aged between 40 and 60 years accounted for 36.8 % of all the cases. The wound treatment rate (12.2 %) and vaccination rate (2.6 %) of rabies cases after exposure were relatively low, while the rabies immunoglobulin utilization rate was only 2.8 %.Conclusions Rabies epidemic cases at the county level overall were increasing in Henan province during the period of 20052013; the epidemic has spread quickly. The data in this study imply that the disease could be better managed by more integrated surveillance across human health and veterinary sectors, improved education and better government policies.

Epidemiological characteristics of human rabies in Henan province in China from 2005 to 2013

Background Rabies is very common in People's Republic of China. Henan province, in the central portion of China, is one of the most densely populated provinces in the entire country. With the new rabies epidemic trend noted in northern and western China, it is necessary to investigate the characteristics of human rabies in this area and control the disease.Methods We chose patients in hospital isolation in 18 municipalities in Henan province as the investigation subjects. Data were collected through systematic reporting from these hospitals, whereas a questionnaire was applied to the relatives of patients.Results A total of 1022 rabies cases were reported. The incidence of human rabies in Henan has increased rapidly since 2005, having peaked in 2007, and maintained a high level in the remaining years. The cases were found mainly in rural areas in the south and east of the province. Rabies was often noted in summer and with the highest number in August. Most cases were noted in males and often in farmers. The patients aged between 40 and 60 years accounted for 36.8 % of all the cases. The wound treatment rate (12.2 %) and vaccination rate (2.6 %) of rabies cases after exposure were relatively low, while the rabies immunoglobulin utilization rate was only 2.8 %.Conclusions Rabies epidemic cases at the county level overall were increasing in Henan province during the period of 2005-2013; the epidemic has spread quickly. The data in this study imply that the disease could be better managed by more integrated surveillance across human health and veterinary sectors, improved education and better government policies.(AU)

Ruptura traumática de traqueia cervical em cão relato de caso / Traumatic cervical trachea rupture in a dog case report

Rupturas traqueais são afecções incomuns na clínica de pequenos animais, no entanto, representam potencial risco de morte aos animais afetados. Este relato objetiva descrever um caso de ruptura traumáticade traqueia cervical, secundária a mordedura em um cão Teckel, macho, com sete anos de idade. Ascomplicações decorrentes da ruptura traqueal foram enfisema subcutâneo generalizado e taquipneia.Como tratamento, realizou-se cirurgia exploratória da região cervical e, depois de identificado o orifício,optou-se pela sutura traqueal com náilon em padrão simples interrompidos. Conclui-se neste caso que o tratamento cirúrgico para ruptura traqueal com traqueorrafia obteve excelentes resultados, sem qualquercomplicação pós-cirúrgica.(AU)

Tracheal ruptures are uncommon in clinical disorders of small animals, however represent potentiallylife threatening to animals affected. The objective is to describe a case of traumatic rupture ofthe cervical trachea secondary to dog bite in a Dachshund male with seven years old. The complicationsof tracheal rupture were general subcutaneous emphysema and tachypnea. The treatmentwas an exploratory surgery of the cervical region and the surgical procedure used was directsuturing in all of tracheal injury in simple interrupted pattern. We conclude in this case that thesurgical treatment and the simple suture of the trachea obtained excellent results without any complications.(AU)

Ruptura traumática de traqueia cervical em cão – relato de caso / Traumatic cervical trachea rupture in a dog – case report

Rupturas traqueais são afecções incomuns na clínica de pequenos animais, no entanto, representam potencial risco de morte aos animais afetados. Este relato objetiva descrever um caso de ruptura traumáticade traqueia cervical, secundária a mordedura em um cão Teckel, macho, com sete anos de idade. Ascomplicações decorrentes da ruptura traqueal foram enfisema subcutâneo generalizado e taquipneia.Como tratamento, realizou-se cirurgia exploratória da região cervical e, depois de identificado o orifício,optou-se pela sutura traqueal com náilon em padrão simples interrompidos. Conclui-se neste caso que o tratamento cirúrgico para ruptura traqueal com traqueorrafia obteve excelentes resultados, sem qualquercomplicação pós-cirúrgica.

Tracheal ruptures are uncommon in clinical disorders of small animals, however represent potentiallylife threatening to animals affected. The objective is to describe a case of traumatic rupture ofthe cervical trachea secondary to dog bite in a Dachshund male with seven years old. The complicationsof tracheal rupture were general subcutaneous emphysema and tachypnea. The treatmentwas an exploratory surgery of the cervical region and the surgical procedure used was directsuturing in all of tracheal injury in simple interrupted pattern. We conclude in this case that thesurgical treatment and the simple suture of the trachea obtained excellent results without any complications.