Allergic Complications of Hyaluronidase Injection: Risk Factors, Treatment Strategies, and Recommendations for Management.

BACKGROUND: Hyaluronidase is used as a reversal agent for hyaluronic acid fillers and to increase the diffusion of other medications after infiltration. Cases of hyaluronidase allergy have been described in the literature since 1984. However, it is still frequently misdiagnosed. This review aims to summarize the current literature to describe the clinical picture of hyaluronidase allergy and identify any risk factors associated with its development, as well as provide recommendations for management in plastic surgery. METHODS: A digital search of PubMed, Scopus, and Embase databases was performed by two reviewers following the PRISMA guidelines. This search identified 247 articles. RESULTS: Two hundred forty-seven articles were identified, and 37 of them met the eligibility criteria. One hundred six patients with a mean age of 54.2 years were included in these studies. History of allergy to other substances (timothy grass, egg white, horse serum, penicillin, insect bites, wasp venom, thimerosal, potassium, histamine, phenylmercuric acetate, and nickel) and allergic diseases (asthma, dermatitis, atopy, rhinitis) was reported. A large portion of the patients with a history of repeated exposure (2-4) experienced the symptoms with their second injection. Nonetheless, there was no significant association between time to allergy development and the number of exposures (P = 0.3). Treatment with steroids +/- antihistamines resulted in the rapid and predominantly complete reversal of the symptoms. CONCLUSIONS: Prior injections or sensitization by insect/wasp venom might be the primary factor associated with hyaluronidase allergy development. The time between the repeated injections is not a likely contributor to the presentation. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Alterações oculares decorrentes de picada de abelha na córnea / Ocular changes due to corneal bee sting

RESUMO O propósito deste estudo foi reportar as alterações oculares observadas após picada de abelha com ferrão retido na córnea. Destacamos o tratamento e o desfecho de uma lesão de córnea incomum e sua patogênese. Trata-se de relato de caso e revisão da literatura de lesões oculares por picada de abelha. Paciente do sexo feminino, 63 anos, procurou atendimento oftalmológico de urgência devido à picada de abelha na córnea do olho direito há 6 dias. Queixava-se de embaçamento visual, dor e hiperemia ocular. Apresentou acuidade visual de vultos no olho afetado. Ao exame, notaram-se hiperemia moderada de conjuntiva bulbar, edema corneano com dobras de Descemet e presença do ferrão alojado na região temporal, no estroma profundo da córnea. A paciente foi internada para ser abordada no centro cirúrgico sob anestesia geral. Durante a cirurgia, o ferrão teve que ser retirado via câmara anterior, mediante a realização de uma paracentese e uma lavagem da câmara anterior, com dupla via e solução salina balanceada. Ainda não existe na literatura um tratamento padrão na abordagem de pacientes com lesões oculares por picada de abelha, sendo importantes a identificação e o reconhecimento precoce de possíveis complicações que ameacem a visão.

ABSTRACT The purpose of this study was to report the ocular changes observed after a bee sting with a stinger retained in the cornea. We show the treatment and outcome of an unusual corneal injury and its pathogenesis. This is a case report and literature review of ocular injuries caused by bee stings. A 63-year-old female patient sought emergency ophthalmic care because of a bee sting on the cornea of her right eye six days before. She complained of blurred vision, pain, and ocular hyperemia. She had glare sensitivity on visual acuity in the affected eye. Examination revealed moderate hyperemia of the bulbar conjunctiva, corneal edema with Descemet's folds and a stinger lodged in the temporal region, in the deep stroma of the cornea. The patient was admitted to the operating room under general anesthesia. During surgery, the stinger had to be removed via the anterior chamber, by performing a paracentesis and washing the anterior chamber with a double flushing and balanced saline solution. There is still no standard treatment in the literature for patients with eye injuries caused by bee stings, and early identification and recognition of possible sight-threatening complications is important.

Sensitivity of a Hymenoptera serological immunoglobulin (Ig)E assay for the diagnosis of venom hypersensitivity in dogs.

BACKGROUND: Hymenoptera envenomation with honey bee (Apis mellifera) and paper wasp (Polistes spp.) may cause life-threatening anaphylaxis in dogs. In human patients, clinical history, intradermal testing (IDT) and measurement of allergen-specific serological immunoglobulin (Ig)E (sIgE) are used to support a diagnosis of Hymenoptera venom hypersensitivity. The utility of venom allergen-specific sIgE has not yet been evaluated for this purpose in dogs. OBJECTIVES: The objective of the study was to investigate the sensitivity (sn), specificity (sp) and positive predictive value (PPV) of honey bee and paper wasp serological titres using a commercially available sIgE assay [VARL (Veterinary Allergen Reference Laboratory) Liquid Gold] against clinical history for a diagnosis of Hymenoptera hypersensitivity in dogs. MATERIALS AND METHODS: Honeybee and paper wasp IgE serum titres were measured in 15 client-owned dogs with a diagnosis of Hymenoptera venom hypersensitivity based on a history of anaphylaxis, owner observation of Hymenoptera, and positive IDT to bee and/or wasp; and in 10 client-owned dogs with no known history of anaphylaxis or Hymenoptera exposure and a negative IDT to bee and wasp. RESULTS: Analysis of receiver operating characteristic (ROC) curves demonstrate that a VARL score cut-off of one of six for honeybee yields Sn, Sp and PPV of 40%, 60% and 60%, respectively, and two of six for wasp yields Sn, Sp and PPV of 25%, 78% and 60%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Owing to the poor sensitivity and PPV of sIgE assays for both bee and wasp hypersensitivity in dogs with known envenomation and anaphylaxis, the use of sIgE cannot be recommended as a tool for venom identification.

Picadura de insecto en la córnea, a propósito de un caso

Introducción : Es de vital importancia considerar que la toxina del veneno de la avispa puede ocasionar una reacción violenta que daña la función visual, es por ello que presentamos el siguiente caso relacionado. Cuadro Clínico : Mujer de 32 años con antecedente de picadura de avispa hace 24 horas en ojo derecho; disminución de la agudeza visual, enrojecimiento, lagrimeo, dolor, secreción; agudeza visual de cuenta dedos a 2 metros del ojo derecho y 20/25 ojo izquierdo, con presiones intraoculares de 12 y 13; biomicroscopía hiperemia conjuntival con inyección periciliar 3+, cuerpo extraño en córnea hasta estoma con edema 3+, estrías en la Descemet ojo derecho. Resultados : Se procede a la extracción del cuerpo extraño con previa protección antimicrobiana con antibiótico tobramicina, antiinflamatorio esteroideo prednisolona, hipertónicas y lubricante mixto carboximetilcelulosa y glicerina. A la semana, se observa la formación de una opacidad capsular anterior con signos de atrofia iridiana que empieza a dar un "cambio de color del iris", a las dos semanas se evidencia la dilatación de la vasculatura periciliar, a horas 4, y a las 3 semanas el paciente presenta una agudeza visual de 20/25 ambos ojos, con transparencia corneal, persistencia de la atrofia iridiana y catarata traumática capsular anterior, con remisión de sintomatología en el paciente. Conclusiones : No se sabe el componente exacto del veneno que produce los signos previamente descritos, existen teorías de que puede deberse a un componente con acción parasimpaticomimética, el mismo que se relaciona a otras observaciones clínicas de despigmentación local y heterocromía.

Introduction : It is very important to consider that the toxin present in wasp venom may lead to a severe reaction damaging visual function. This is the reason why we present the following case. Clinical Picture : This is a 32-year-old-female who was bitten by a wasp 24 hours ago in her right eye. She had visual acuity reduction, reddening, tearing, pain, and secretion. Her visual acuity was counting fingers at two-meter distance from her right eye and 20/25 in the left eye. Intraocular pressure was 12 and 13. Biomicroscopy showed conjunctival hiperemia with 3+ periciliary injection. There was a foreign body in the cornea towards the stoma, with 3+ edema. There were striae in the right Descemet. Resultados: We took out the foreign body with previous antimicrobial protection including an antibacterial (tobramycin) and a steroid anti-inflammatory compound (prednisolone). Hypertonic solution and mixed lubricants were also administered, including a mixed lubricant, carboxymethylcellulose, and glycerin. One week afterwards, we observed the formation of an anterior capsular opacity with signs of iris atrophy which led to a 'change of color in the iris'. Two weeks afterwards we observed periciliary vascular dilatation, at 4-hour meridian; and on the third week, the patient had 20/25 visual acuity in both eyes. Her cornea was transparent, there was persistence of iris atrophy, and there was an anterior capsular cataract. Her symptoms subsided. Conclusiones : The exact component of wasp venom leading to the described signs is not known. It has been proposed that it may be a compound with parasympathomimetic action, and this has been related with other clinical observations indicating local depigmentation and heterochromia.

Anaphylaxis reaction to Samsum ant (Pachycondyla sennaarensis): a case series study.

Summary: Background. Anaphylaxis is a life-threatening hypersensitivity reaction. The present study aimed to investigate the cases of anaphylaxis to ant stings in Iran to determine the characteristics of patients, geographical distribution and the type of ants that cause anaphylaxis. Methods. Patients with a history of anaphylaxis to ant sting underwent skin allergy test with extracted substance from Solenopsis invicta. Samples of ants were collected from the sites where each patient was bitten and their species were identified by a medical entomologist. Results. Nineteen patients (mean age: 26.2 years; range: 4-48 years) were included in the study. Most patients (89.5 percent) were female. The lower limb was the most common site of the sting and most stings had occurred in the morning (31.6 %) and evening (31.6%). Skin manifestations were the most common clinical symptoms (94.7%). Most cases of stings were observed in the Hormozgan province (89.5%) located in southern Iran. Sixteen patients had positive skin prick test for ant venom. All collected ants that caused anaphylaxis belonged to the Pachycondyla sennaarensis species. Conclusions. Ant sting anaphylaxis is not uncommon in Iran, especially in its southern regions. All cases of anaphylaxis in this study were due to samsum ant sting (Pachycondyla sennaarensis), which is a species similar to the fire ant (Solenopsis invicta). Allergy skin testing with fire ant extract was positive and helpful in identifying samsum ant allergy in all cases.

Wilderness Medical Society Clinical Practice Guidelines on Anaphylaxis.

The Wilderness Medical Society convened a panel to review the literature and develop evidence-based clinical practice guidelines on the treatment of anaphylaxis, with an emphasis on a field-based perspective. The review also included literature regarding the definition, epidemiology, clinical manifestations, and prevention of anaphylaxis. The increasing prevalence of food allergies in the United States raises concern for a corresponding rise in the incidence of anaphylaxis. Intramuscular epinephrine is the primary treatment for anaphylaxis and should be administered before adjunctive treatments such as antihistamines, corticosteroids, and inhaled ß agonists. For outdoor schools and organizations, selecting a method to administer epinephrine in the field is based on considerations of cost, safety, and first responder training, as well as federal guidelines and state-specific laws.

Medical care at a mass gathering music festival : Retrospective study over 7 years (2011-2017).

BACKGROUND: Knowledge about longitudinal changes in epidemiological data at mass gathering events is sparse. The goal of this study was to determine and compare the type, severity and frequency of illnesses at a large music festival over 7 consecutive years (2011-2017). METHODS: Prospectively collected data from the rescue operation protocols of an Austrian music festival were retrieved and analyzed. Patient presentation rates (PPR) and transport to hospital rates (TTHR) were calculated and compared between years. Linear regression was used to investigate the association between (a) total number of visitors and number of patient presentations, and (b) environmental factors and temperature related medical emergencies. A descriptive analysis of pertinent medical logistics management was performed. RESULTS: The median (minimum to maximum) PPR and TTHR were 12.01 (9.33 in 2016 to 20.86 in 2011) and 0.57 (0.40 in 2017 to 1.06 in 2013) per 1000 visitors, respectively. In linear regression models, no significant associations were found between the number of visitors and either the total number of patient presentations, NACA 1-2 or NACA 3-5 classified emergencies. Environmental temperature had a significant impact on heat related patient presentations (p < 0.001). CONCLUSION: There were significant differences and a high variance in both PPR and TTHR over the years. Contrary to our expectations, the number of visitors did not predict the number of patient presentations. Ambient temperature was associated with the number of heat related emergencies but not with the number of cold related emergencies. Prevention strategies, such as the removal of insect nests, resulted in significantly fewer insect related emergencies.

Clinical effects and factors associated with adverse clinical outcomes of hymenopteran stings treated in a Thai Poison Centre: a retrospective cross-sectional study.

OBJECTIVE: To describe clinical effects and outcomes of hymenopteran stings and to explore the non-laboratory factors associated with adverse clinical outcomes, a composite outcome including death, respiratory failure requiring intubation, acute kidney injury (AKI) requiring dialysis and hypotension requiring vasopressor use. METHODS: A retrospective cross-sectional study was performed at the Ramathibodi Poison Center, a poison centre of a tertiary care hospital in Thailand. All cases of hymenopteran sting consultations from January 2015 to June 2019 were consecutively enrolled, and charts were reviewed. Demographics, initial clinical characteristics and outcomes were collected. Factors associated with adverse clinical outcome were explored. RESULTS: One hundred and fourteen hymenopteran stings cases (wasp 48%, bee 33%, hornet 14% and carpenter bee 8.8%) were included (median age, 36.5 years (interquartile range 9-55); male 63%). The prevalence of adverse clinical outcomes was 12.3% (95%CI 6.88-12.8). At initial presentation, 100% of cases had local skin reactions, 11.4% were clinical anaphylaxis, and 8% had red urine. Adverse clinical outcomes included death (n = 10), respiratory failure requiring intubation (n = 9), AKI requiring dialysis (n = 6) and hypotension requiring vasopressor use (n = 2). None of the patients with carpenter bee or hornet stings developed adverse clinical outcomes. In univariable analysis, urticaria, wheezing, red urine, wasp sting and sting number > 10 were significantly associated with adverse clinical outcomes. In multivariable analysis, red urine (adjusted OR 11.1 (95% CI 1.57-216)), wheezing (adjusted OR 16.7 (95% CI 1.43-402)) and a number of stings > 10 (adjusted OR 21.5 (95% CI2.13-2557)) were significant. CONCLUSIONS: Adverse clinical outcomes in hymenopteran stings were not uncommon among cases inquiring to a national Thai poison centre. At initial presentation, red urine, wheezing and a number stings >10 were significantly associated with adverse clinical outcomes. Larger epidemiologic studies are required to confirm these associations.

Effectiveness of antibiotic prophylaxis in patients with centipede stings: a randomized controlled trial.

OBJECTIVE: Centipede stings are a common problem in tropical countries. Current treatment guidelines do not include recommendations for antibiotic prophylaxis to prevent the associated bacterial infection since no previous study has assessed the effectiveness of antibiotic treatment in patients bitten by centipedes. Thus, this study aimed to compare the effectiveness of antibiotic prophylaxis over placebo for the skin infections that occur after a centipede sting. METHODS: In this randomized, double-blind, multi-center clinical trial conducted in the emergency departments in four hospitals, patients with any history of a centipede sting were prospectively enrolled and divided randomly into two groups. One group received dicloxacillin and the other a placebo. The primary outcome was the incidence of wound infection 3 to 5 days after the centipede sting. RESULTS: From December 2014 to October 2015, a total of 83 patients were enrolled in the study and were randomized into antibiotic (n=43) and placebo (n=40) groups. Two patients in the antibiotic group developed wound infections, while none showed wound infection in the placebo group (5% vs. 0%). The wound infection rate did not differ significantly between the two groups (P=0.496). CONCLUSION: Antibiotic prophylaxis may be unnecessary in cases of centipede stings. Proper wound care is an adequate and appropriate treatment for patients with centipede stings. However, the patient should be re-evaluated for detection of secondary bacterial infection.

Nephrotic syndrome after insect sting: a case report / Síndrome nefrótica após picada de inseto: relato de caso

ABSTRACT Minimal change disease accounts for up to 25% of the cases of nephrotic syndrome in adult population. The allergic mechanism has been associated with minimal change disease and allergens have been implied, namely insect stings. We present a case report of a woman with new onset of nephrotic syndrome after a non-hymenoptera insect sting, with biopsy-proven minimal change disease, that was accompanied by a pulmonary thromboembolism process. Complete remission with glucocorticoid therapy was observed, with sustained response for 6 months after discontinuation. A new exposure to insect sting in the same geographical region and season triggered a nephrotic syndrome relapse. Subsequent avoidance of the place resulted in a sustained remission for more than 4 years.

RESUMO A doença de lesões mínimas é responsável por até 25% dos casos de síndrome nefrótica na população adulta. O mecanismo alérgico tem sido associado à doença de lesão mínima a associada a alérgenos, como picadas de insetos. Apresentamos um caso de uma mulher com início recente de síndrome nefrótica após picada de inseto não himenóptero, com doença de lesões mínimas comprovada por biópsia, acompanhada por um processo de tromboembolismo pulmonar. A paciente teve remissão completa com glicocorticoides, com resposta sustentada por 6 meses após a interrupção do tratamento. Uma nova exposição à picada de inseto na mesma região geográfica e estação do ano provocou uma recaída da síndrome nefrótica. Evitar o local subsequentemente resultou em remissão sustentada por mais de 4 anos.

Acute bullous hemorrhagic prurigo: a diagnostic challenge

Abstract Insect bites and bite wounds are quite common and most often have mild repercussions in humans. Statistics on the incidence of accidents caused by insects are not available, and the skin reactions after the bites are not always known. The authors present two cases of patients with hemorrhagic blisters on their hands after tabanidae bites and discuss the factors that cause the problem and the importance of the differential diagnosis of blisters with hemorrhagic content on human skin.

Acute bullous hemorrhagic prurigo: a diagnostic challenge.

Insect bites and bite wounds are quite common and most often have mild repercussions in humans. Statistics on the incidence of accidents caused by insects are not available, and the skin reactions after the bites are not always known. The authors present two cases of patients with hemorrhagic blisters on their hands after tabanidae bites and discuss the factors that cause the problem and the importance of the differential diagnosis of blisters with hemorrhagic content on human skin.

Reasons for Declining Venom Immunotherapy.

INTRODUCTION: Hymenoptera venom allergy is associated with significant morbidity and deterioration in health-related quality of life, and risk of fatal systemic reactions. Although venom immunotherapy is safe and the only effective treatment in allergic individuals, some patients prefer not to pursue this treatment. Since 2011, when the 50% reimbursement was stopped, patients must fully support the cost of immunotherapy. This study aimed to ascertain the reasons why patients decline immunotherapy. MATERIAL AND METHODS: A medical records review of all patients proposed to receive venom immunotherapy at an Allergy and Clinical Immunology Department in Porto, Portugal, between 2006 and 2015, followed by a phone interview to patients refusing treatment. RESULTS: A total of 83 subjects were enrolled, with a mean (± SD) age of 44.4 (14.7) years and 55 (66%) males; 27 refused venom immunotherapy between 2006 and 2015. Nineteen were interviewed and 14 of those stated price as the main reason for declining treatment. The only identified risk factor associated with immunotherapy refusal was being proposed after 2011 (OR: 3.29; 95% CI: 1.12 - 9.68; p = 0.03). DISCUSSION: The number of patients refusing venom immunotherapy doubled since reimbursement was withdrawn. Price was identified as the major obstacle to treatment completion. Immunotherapy proposal after reimbursement was stopped was associated with a 3-fold increase in the risk of refusing treatment. CONCLUSION: These findings show how economic decisions may have a detrimental effect on patient care, as immunotherapy refusal left them exposed to an avoidable life-threatening risk.

Introdução: A alergia a veneno de himenópteros está associada a uma significativa morbilidade e diminuição da qualidade de vida, bem como a risco de reações alérgicas fatais. Apesar da imunoterapia com veneno de himenópteros ser um tratamento seguro e o único eficaz nesta patologia, alguns doentes decidem não o realizar. Desde 2011, quando a comparticipação de 50% terminou, o custo da imunoterapia é totalmente suportado pelos doentes. Este trabalho pretendeu identificar os motivos da recusa desta terapêutica. Material e Métodos: Revisão dos registos clínicos de todos os doentes propostos para imunoterapia com veneno de himenópteros num serviço de Imunoalergologia, no período 2006 - 2015, seguida de entrevista telefónica aos que a recusaram. Resultados: Foram incluídos 83 doentes, com uma idade média (± DP) de 44,4 (14,7) anos. Cinquenta e cinco (66%) eram homens; 27 recusaram imunoterapia entre 2006 e 2015. Dezanove foram entrevistados e 14 identificaram o preço como principal motivo de recusa. O único fator de risco identificado para a recusa de imunoterapia foi ser proposta depois de 2011 (OR: 3,29; 95% CI: 1,12 ­ 9,68; p = 0,03). Discussão: O número de doentes a recusar imunoterapia duplicou desde que a comparticipação foi retirada. O preço foi o principal obstáculo à realização do tratamento. Ser proposto após o término da comparticipação do tratamento aumentou em três vezes o risco de recusa. Conclusão: Estes achados revelam o impacto negativo de uma decisão económica na saúde e segurança destes doentes, já que a recusa da imunoterapia os manteve expostos a um risco de vida evitável.

Tick-induced allergies: mammalian meat allergy and tick anaphylaxis.

Mammalian meat allergy after tick bites and tick anaphylaxis are the most serious tick-induced allergies. They are often severe, should be largely avoidable and offer fascinating insights into the development and prevention of allergies. Australian clinicians reported the first cases of tick anaphylaxis and discovered the association between tick bites and the development of mammalian meat allergy. The subsequent finding of the allergen epitope within the meat responsible for the allergic reaction, α-gal (galactose-α-1,3-galactose), stimulated further interest in this emergent allergy. Reports of mammalian meat allergy associated with bites from several tick species have now come from every continent where humans are bitten by ticks. The number of diagnosed patients has continued to rise. Clinically, mammalian meat allergy and tick anaphylaxis present quite differently. The prominent role of cofactors in triggering episodes of mammalian meat allergy can make its diagnosis difficult. Management of mammalian meat allergy is complicated by the manifold potential therapeutic implications due to the widespread distribution of the mammalian meat allergen, α-gal. Exposures to α-gal-containing medications have proved lethal in a minority of people, and fatal tick anaphylaxis has been reported in Australia. Prevention of tick bites is prudent and practicable; killing the tick in situ is crucial to both primary and secondary prevention of allergic reactions. Mechanisms in the development of mammalian meat allergy constitute a paradigm for how allergies might arise.

Assessment on the ownership and use of mosquito nets in Mozambique / Avaliação sobre a posse e uso de redes mosquiteiras em Moçambique

ABSTRACT OBJECTIVE To assess the ownership and use of mosquito nets in 2014, in Mozambique. METHODS This observational and cross-sectional study assessed, in February and March 2015, 69 districts (nine of 11 provinces of Mozambique) that have benefited from the mass distribution of mosquito nets. The Lot Quality Assurance Sampling methodology was used. Each locality was denominated supervision area. The Lot Quality Assurance Sampling opts for a minimum of 19 households (in this case, we decided for a minimum of 100 households per district) from each supervision area to assess an indicator (in this case, two indicators were assessed: ownership and use of mosquito nets). Two questions guided the research: a) received a mosquito net; b) used a mosquito net the night before. RESULTS A total of 6,725 households were assessed. Eighty three percent of them had received mosquito nets in the campaign. Of the 6,232 respondents, 82.0% said they used mosquito nets the night before. The districts of the provinces with low coverage of ownership and use were Tete (69.5% and 60.0%, respectively), Zambezia (79.0% and 60.0%, respectively), and Gaza (81.6% and 70.7%, respectively). The largest coverage of ownership and use were observed in the districts of Nampula (96.7% and 93.8%, respectively) and Niassa (86.0% and 85.4% respectively). CONCLUSIONS In the districts assessed, the progression of ownership and use of mosquito nets is satisfactory. Nampula and Niassa are the only provinces where ownership and use are at desired levels.

RESUMO OBJECTIVO Avaliar a posse e o uso das redes mosquiteiras no ano de 2014 em Moçambique. MÉTODOS Este estudo observacional transversal avaliou, em fevereiro e março de 2015, 68 distritos (nove das 11 províncias de Moçambique) que se beneficiaram da distribuição de redes em massa. Usou-se a metodologia Lot Quality Assurance Sampling. Cada localidade foi designada de área de supervisão. O Lot Quality Assurance Sampling opta por um mínimo de 19 agregados familiares (neste caso decidiu-se um mínimo de 100 agregados familiares por distrito) de cada área de supervisão, a fim de avaliar um indicador (neste caso dois indicadores foram avaliados: posse e uso de redes mosquiteiras). Duas perguntas nortearam a pesquisa: a) recebeu rede; b) usou rede na noite anterior. RESULTADOS Foram avaliados 6.725 agregados familiares . Desses, 83,0% tinham recebido redes na campanha. Dos 6.232 inqueridos, 82,0% disseram que usaram na noite anterior. As províncias com distritos com menores coberturas de posse e uso foram Tete (69,5% e 60,0%, respectivamente), Zambézia (79,0% e 60,0%, respectivamente) e Gaza (81,6% e 70,7%, respectivamente). As maiores coberturas de posse e uso foram observadas nos distritos de Nampula (96,7% e 93,8%, respectivamente) e Niassa (86,0% e 85,4%, respectivamente). CONCLUSÕES Nos distritos avaliados, a progressão para a posse e uso de redes mosquiteiras é satisfatória. Nampula e Niassa são as únicas províncias onde a posse e o uso estão em níveis desejados.

Conhecimento de puérperas sobre identificação e prevenção do acidente loxoscélico / Puerperal women's knowledge on the identification and prevention of loxoscelic acidentes / Conocimiento de las puérperas sobre la identificación y prevención de accidentes loxoscélicos

Objetivos: este estudo teve como objetivo identificar o grau de conhecimento que puérperas possuíam a respeito da aranha Loxosceles, sua picada e conduta no caso de acidente com elas ou seus filhos. Métodos: estudo transversal quantitativo, que utilizou um questionário estruturado abrangendo perfil socioeconômico, conhecimento sobre aranha-marrom e o loxoscelismo. Foram incluídas pacientes em puerpério imediato, considerado entre o primeiro e décimo dia do parto, internadas na maternidade do Hospital do Trabalhador em Curitiba-PR, entre julho e outubro de 2011. Participaram 208 puérperas, das quais oito foram excluídas porque os questionários foram preenchidos de forma incorreta. Os dados obtidos foram tabulados no programa Microsoft Excel 2007® e analisados pelos testes χ2 e Exato de Fisher. Resultados: sobre o conhecimento da aranha, 61% das puérperas afirmaram reconhecer a aranha e apontaram a imagem correta. Sobre a conduta em caso de acidente, 87,5% responderam a conduta correta, porém apenas 37% apontaram a sintomatologia correta. Hipóteses testadas mostraram que idade, escolaridade e acidente loxoscélico prévio são diretamente proporcionais ao conhecimento das participantes (p<0,05). Conclusão: a maioria das puérperas pesquisadas conhecia a aranha-marrom e grande parte reconhecia a lesão provocada pela picada, mas a gravidade da lesão foi superestimada. Contraditoriamente, o conhecimento dos sintomas foi pequeno, o que pode levar ao atraso do tratamento delas mesmas ou dos seus filhos. O conhecimento da aranha foi diretamente relacionado à idade, escolaridade e a acidente loxoscélico prévio.

Objectives: this study aimed to identify puerperal women's level of knowledge about the Loxosceles spider, its bite, and their own conduct in the event of a loxoscelic accident involving them or their children. Methods: this was a quantitative cross-sectional study using a structured questionnaire that included the socioeconomic profile of the participants, and knowledge about the brown spider and loxoscelism. Participants included postpartum women (between the first to tenth day of delivery), admitted to the maternity ward of the Hospital do Trabalhador, Curitiba-PR, between July and October 2011. From a total of 208 postpartum women, eight were excluded because the questionnaires were filled incorrectly. Data were tabulated using Microsoft Excel 2007® and analyzed using the χ2 test and Fisher's exact test. Results: regarding the knowledge about the spider, 61% of the participants said that they knew the spider and identified the correct picture. About their conduct in case of loxoscelic accidents, 87.5% gave appropriate responses, but only 37% identified the correct symptoms. Hypothesis testing revealed that age, education, and prior experience of loxoscelic accidents were directly proportional to the participants' knowledge (p<0.05). Conclusion: most of the women surveyed could identify the brown spider and largely recognized the spider's bite injury, but they overestimated its severity. On the contrary, they had little knowledge about the symptoms, which may lead to delayed treatment for them or their children. The participants' knowledge about the spider was directly related to age, education, and prior experience of a loxoscelic accident.

Objetivos: este estudio tuvo como objetivo identificar el grado de conocimiento que las puérperas tenían respeto la araña Loxosceles, su picadura y la conducta en el caso de un accidente con ellas o sus hijos. Métodos: estudio transversal cuantitativo en que se utilizó un cuestionario estructurado con el perfil socio-económico, el conocimiento sobre la araña marrón y el Loxoscelismo. Las pacientes incluidas fueron aquellas en el período inmediatamente posterior al parto, del primero hasta el décimo día puerperal, admitidas en la Maternidad y Hospital del Trabajador en Curitiba- PR, entre julio y octubre del 2011. Participaron 208 puérperas, de las cuales ocho fueron prohibidas debido a que sus cuestionarios fueron completados incorrectamente. Los datos fueron tabulados en Microsoft® Excel 2007 y analizados mediante el Test de χ2 y Exacto de Fisher. Resultados: respeto al conocimiento de la araña, el 61% de las madres dijeron reconocer la araña y apuntaron a la imagen correcta. Acerca de la conducta en caso de accidentes, el 87,5% respondieron la conducta correcta, pero sólo el 37% identificaron los síntomas correctos. Las hipótesis testadas mostraron que la edad, la educación y el accidente loxoscélico anterior son directamente proporcionales a los conocimientos de las participantes (p<0,05). Conclusión: la mayoría de las mujeres encuestadas conocía la araña marrón y en gran parte reconoció el daño causado por la picadura, pero sobrestimaran la gravedad de las lesiones. Paradójicamente, el conocimiento de los síntomas fue pequeño, lo que puede llevar al retraso del tratamiento para sí mismas o para sus hijos. El conocimiento sobre la araña estuvo directamente relacionado con la edad, la educación y el accidente loxoscélico anterior

Alergia a himenópteros: do ambulatório à urgência / Hymenoptera venom allergy: outpatient aspects and urgency

Os acidentes com himenópteros são comuns na infância, provavelmente pelo fato de as crianças estarem mais expostas ao ar livre. A maioria das reações é secundária ao efeito tóxico do veneno e limitada ao local da picadura, sendo sua abordagem feita ambulatorialmente. As reações extensas, as anafiláticas e as tóxicas graves poderão necessitar, além da abordagem ambulatorial, cuidados hospitalares e tratamento intensivo. As manifestações alérgicas resultam de uma reação de hipersensibilidadedo tipo I, mediada pela imunoglobulina E (IgE), a componentes reconhecidos como alérgenos contidos no veneno dos insetos da ordem Hymenoptera, em indivíduos previamente sensibilizados. As reações sistêmicas na infância são incomuns, atingindo menos de 1% dos casos, mas em adultos essa prevalência pode atingir 8,9%. A história clínica detalhada é imprescindível para determinar as condutas diagnóstica e terapêutica, assim como a orientação quanto às medidas preventivas para cadacaso. Os testes cutâneos por puntura e/ ou intradérmicos são os de escolha para o diagnóstico. No entanto, os testes in vivo e in vitro são considerados complementares, já que nenhum deles isoladamente identifica todos os pacientes verdadeiramente alérgicos. O grau de sensibilidade demonstrado nesses testes não se correlaciona com a gravidade dos sintomas.

Accidents with Hymenoptera are common in childhood probably because children are more exposed to the outdoors. Most of the reactions to their poison toxic effect are secondary and confined to the site of the sting, and treatment is performed in the outpatient clinic. Extensive, toxic, and severe anaphylactic reactions may require hospital care and intensive treatment in addition to the outpatient approach. Allergic manifestations result from a type I hypersensitivity reaction, mediated by immunoglobulin E (IgE) in previously sensitized individuals to components recognized as allergens, present in the venom of insects from the Hymenoptera order. Systemic reactions are uncommon in childhood patients, reaching less than 1% of cases, however, this prevalence can reach 8.9% in adults. A detailed medical history is essential to determine diagnostic and therapeutic protocols, as well as guidance for preventative measures in each case. Skin prick and/or intradermal tests are the choice for diagnosis. However, in vivo and in vitro tests are considered complementary because none of them, individually, identifies all patients who are truly allergic. The degree of sensitivity demonstrated in these tests does not correlate with the severity of symptoms.

Dermoscopy as an auxiliary method in the diagnosis of social wasp (Hymenoptera, Vespidae) stings

We describe the case of a 32-year-old male patient that sought medical treatment complaining of severe pain in his second and third right-hand fingers. The symptoms had started two hours before. The hypotheses of spider bite, scorpion or insect sting and injury caused by a foreign body were considered in the differential diagnoses. On dermoscopy, two foreign bodies were identified on his skin. After extraction, we concluded that they were wasp stingers.