"Bad things come in small packages": predicting venom-induced coagulopathy in Bothrops atrox bites using snake ontogenetic parameters.

Introduction: Snake venom composition shows significant inter- and intra-species variation. In the case of the viperid species Bothrops atrox, responsible for the majority of snakebites in the Amazon region, geographical and ontogenetic variables affect venom composition, with ecological and medical implications. Previous studies had shown that venom from neonate and juvenile Bothrops specimens have a higher in vitro coagulant activity. The aim of this investigation was to assess the association of clinical outcomes, such as venom-induced coagulopathy and local complications, with B. atrox ontogenetic variables.Methods: This study explored the relationship between some clinical parameters in patients suffering envenomations by B. atrox in the Amazon and several morphometric parameters of the snake specimens causing the bites.Results: There were 248 specimens confirmed as agents of envenomation, mostly female snakes (70.5%) and classified as juveniles (62.7%). Patients bitten by neonates compared to adult snakes [OR = 2.70 (95%CI 1.15-6.37); p = .021] and by snakes with white tail tip [OR = 1.98 (95%CI 1.15-3.41); p = .013] were more likely to develop coagulopathy. Time from patient admission to the unclottable blood reversion was not affected by the snake gender (p = .214) or age (p = .254). Patients bitten by neonate (p = .024) or juvenile snakes (p < .0001) presented a lower frequency of moderate to severe edema, as compared to those bitten by adult snakes. In agreement with experimental observations, patients bitten by neonates and by snakes with a white tail tip were more likely to develop coagulopathy than those bitten by adult snakes. In contrast, envenomations by adult snakes were associated with a higher incidence of severe local edema.Conclusion: Despite these variations, no difference was observed in the time needed to recover blood clotting in these patients after Bothrops antivenom administration.

Bad things come in small packages: predicting venom-induced coagulopathy in Bothrops atrox bites using snake ontogenetic parameters

Introduction: Snake venom composition shows significant inter- and intra-species variation. In the case of the viperid species Bothrops atrox, responsible for the majority of snakebites in the Amazon region, geographical and ontogenetic variables affect venom composition, with ecological and medical implications. Previous studies had shown that venom from neonate and juvenile Bothrops specimens have a higher in vitro coagulant activity. The aim of this investigation was to assess the association of clinical outcomes, such as venom-induced coagulopathy and local complications, with B. atrox ontogenetic variables. Methods: This study explored the relationship between some clinical parameters in patients suffering envenomations by B. atrox in the Amazon and several morphometric parameters of the snake specimens causing the bites.Results: There were 248 specimens confirmed as agents of envenomation, mostly female snakes (70.5%) and classified as juveniles (62.7%). Patients bitten by neonates compared to adult snakes [OR=2.70 (95%CI 1.15-6.37); p=.021] and by snakes with white tail tip [OR=1.98 (95%CI 1.15–3.41); p=.013] were more likely to develop coagulopathy. Time from patient admission to the unclottable blood reversion was not affected by the snake gender (p=.214) or age (p=.254). Patients bitten by neonate (p=.024) or juvenile snakes (p<.0001) presented a lower frequency of moderate to severe edema, as compared to those bitten by adult snakes. In agreement with experimental observations, patients bitten by neonates and by snakes with a white tail tip were more likely to develop coagulopathy than those bitten by adult snakes. In contrast, envenomations by adult snakes were associated with a higher incidence of severe local edema. Conclusion: Despite these variations, no difference was observed in the time needed to recover blood clotting in these patients after Bothrops antivenom administration.

"Bad things come in small packages": predicting venom-induced coagulopathy in Bothrops atrox bites using snake ontogenetic parameters

Introduction: Snake venom composition shows significant inter- and intra-species variation. In the case of the viperid species Bothrops atrox, responsible for the majority of snakebites in the Amazon region, geographical and ontogenetic variables affect venom composition, with ecological and medical implications. Previous studies had shown that venom from neonate and juvenile Bothrops specimens have a higher in vitro coagulant activity. The aim of this investigation was to assess the association of clinical outcomes, such as venom-induced coagulopathy and local complications, with B. atrox ontogenetic variables. Methods: This study explored the relationship between some clinical parameters in patients suffering envenomations by B. atrox in the Amazon and several morphometric parameters of the snake specimens causing the bites.Results: There were 248 specimens confirmed as agents of envenomation, mostly female snakes (70.5%) and classified as juveniles (62.7%). Patients bitten by neonates compared to adult snakes [OR=2.70 (95%CI 1.15-6.37); p=.021] and by snakes with white tail tip [OR=1.98 (95%CI 1.15–3.41); p=.013] were more likely to develop coagulopathy. Time from patient admission to the unclottable blood reversion was not affected by the snake gender (p=.214) or age (p=.254). Patients bitten by neonate (p=.024) or juvenile snakes (p<.0001) presented a lower frequency of moderate to severe edema, as compared to those bitten by adult snakes. In agreement with experimental observations, patients bitten by neonates and by snakes with a white tail tip were more likely to develop coagulopathy than those bitten by adult snakes. In contrast, envenomations by adult snakes were associated with a higher incidence of severe local edema. Conclusion: Despite these variations, no difference was observed in the time needed to recover blood clotting in these patients after Bothrops antivenom administration.

Snakebite by Micrurus averyi (Schmidt, 1939) in the Brazilian Amazon basin: Case report.

Micrurus snakes, commonly known as coral snakes, are responsible for 0.4% of the snakebites envenomings in Brazil. In this report, we describe a case of envenoming by Micrurus averyi, the black-headed coral snake, recorded in the western Brazilian Amazon. To the best of our knowledge, this is the first published case perpetrated by this species. The major complaint of the patient was an intense local pain and paresthesia. Examination of the bite site revealed edema extending from the left foot up the left leg that was accompanied by erythema involving the foot and distal third of the leg. Systemic signs at admission included nausea and drooling. The patient was treated with 100 mL of coral snake antivenom and intravenous analgesics (dipyrone) and was discharged 48 h post-admission with no complaints. The patient showed more intense local edema than that generally described in several other cases of Micrurus bites in Brazil.

Violência, gênero e cor no Estado de São Paulo / Violence, gender and colour in the State of São Paulo

O presente trabalho discute a importância do registro das notificações de casos de violência no Sistema Nacional de Informação em Saúde (SIS). Considera violência como definido pela Organização Mundial da Saúde: o uso de força física ou poder, em ameaça ou na prática, contra si próprio, outra pessoa ou contra um grupo ou comunidade que resulte ou possa resultar em sofrimento, morte, dano psicológico, desenvolvimento prejudicado ou privação, que em suas mais diversas manifestações vem sendo compreendida como impactantes no perfil socioepidemiológico da sociedade. A inclusão desses eventos no rol dos agravos à saúde passíveis de notificação compulsória permite a coleta sistemática e a consolidação de dados, possibilitando a proposição de considerações sobre a ocorrência dos atos de violência relacionando-os a variáveis que envolvem tanto as vítimas quanto os agressores. Com base nos dados para o Estado de São Paulo, realiza-se a reflexão sobre as notificações registradas de violência e as variáveis de gênero e de cor.

Ações em DST/HIV/Aids em unidades básicas de saúde e planos de ações e metas: apontamentos sobre quatro municípios paulistas

A descentralização das ações referentes ao enfrentamento da epidemia de HIV/Aids através da incorporação progressiva destas ações pela Rede de Atenção Básica a Saúde, vem sendo a estratégia desenvolvida pelo Estado de São Paulo, em razão das atuais tendências epidemiológicas. Para tanto, esta descentralização vem sendo monitorada através de metodologia especialmente desenvolvida pelo Programa Estadual de DST/Aids de São Paulo. Paralelamente, o Ministério da Saúde, através do Programa Nacional de DST/Aids estabeleceu a política de incentivo as ações em DST/Aids, possibilitando a estados e municípios receberem recursos específicos a estas ações, através da pactuação de metas. O presente trabalho tem por objetivo verificar se, por ocasião da pactuação de metas, houve, por parte dos municípios, a pactuação de metas referente à descentralização das ações para a Rede de Atenção Básica, bem como, a maneira pela qual tais metas vêm sendo cumpridas, ou não. Para tanto, foi utilizada a aproximação qualitativa, para o desenvolvimento de estudo comparativo de casos, junto a quatro municípios paulistas.

Ações em DST/HIV/Aids em unidades básicas de saúde e planos de ações e metas: apontamentos sobre quatro municípios paulistas / Action in DST/HIV/Aids in basic units of health and plans of action and goals: notes on four São Paulo cities

A descentralização das ações referentes ao enfrentamento da epidemia de HIV/Aids através da incorporação progressiva destas ações pela Rede de Atenção Básica a Saúde, vem sendo a estratégia desenvolvida pelo Estado de São Paulo, em razão das atuais tendências epidemiológicas. Para tanto, esta descentralização vem sendo monitorada através de metodologia especialmente desenvolvida pelo Programa Estadual de DST/Aids de São Paulo. Paralelamente, o Ministério da Saúde, através do Programa Nacional de DST/Aids estabeleceu a política de incentivo as ações em DST/Aids, possibilitando a estados e municípios receberem recursos específicos a estas ações, através da pactuação de metas. O presente trabalho tem por objetivo verificar se, por ocasião da pactuação de metas, houve, por parte dos municípios, a pactuação de metas referente à descentralização das ações para a Rede de Atenção Básica, bem como, a maneira pela qual tais metas vêm sendo cumpridas ou não. Para tanto, foi utilizada a aproximação qualitativa, para o desenvolvimento de estudo comparativo de casos, junto a quatro municípios paulistas.