Eastern Mediterranean Health Journal [2022; Vol.28, Issue 12]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: a scoping review

Bothrops are one of the most common medically important snakes found in Latin America. Its venom is predominantly hemotoxic and proteolytic, which means that local lesion (edema and redness) and hemorrhagic symptoms are recurrent in envenoming by this snake. Although hemorrhage is usually the major cause of death, snakebite-related acute kidney injury is another potentially fatal clinical complication that may lead to chronic kidney disease. The present review highlights the main studies on Bothrops venom-related acute kidney injury, including observational, cross-sectional, case-control and cohort human studies available up to December 2019. The following descriptors were used according to Medical Subject Headings (MeSH): on Medline/Pubmed and Google Scholar "acute kidney injury" or "kidney disease" and "Bothrops"; on Lilacs and SciELO "kidney disease" or "acute kidney injury" and "Bothrops". Newcastle-Ottawa quality assessment scale was used to appraise the quality of the cross-sectional and cohort studies included. The selection of more severe patients who looked for health care units and tertiary centers is a risk of bias. Due to the methodological heterogeneity of the studies, a critical analysis of the results was performed based on the hypothesis that the design of the included studies influences the incidence of acute kidney injury. Fifteen human studies (total participants 4624) were included according to stablished criteria. The coagulation abnormalities (hemorrhagic symptoms, abnormal fibrinogen and activated partial thromboplastin time) were associated with acute kidney injury in the most recent studies reported. The findings observed in this review provide up-to-date evidence about the acute kidney injury pathogenesis following Bothrops syndrome. Studies pointed out that coagulation abnormalities comprise the major pathway for acute kidney injury development. This review may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment of Bothrops venom-related acute kidney injury.(AU)

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

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

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

Extractivism of palm tree fruits: A risky activity because of snakebites in the state of Acre, Western Brazilian Amazon

Abstract INTRODUCTION: We present here the risk from snakebites because of palm extractivism in western Amazonia. METHODS: The data were extracted from a cross-sectional sample study, from January 2016 to April 2018, at the Juruá Regional Hospital of Cruzeiro do Sul (Acre). RESULTS: There were 14 Bothrops incidents involving males, most of them occurring during the harvesting of "açaí" (Euterpe precatoria). CONCLUSIONS: During the harvesting of "açaí," there is the risk of the presence of B. atrox on the ground near the palm tree, and of B. bilineatus at the top of the palm tree.

Perfil epidemiológico del accidente ofídico en las tierras bajas de Guatemala / Epidemiological profile of the ophidian accident in the Guatemalan lowlands

Se describe el perfil epidemiológico del accidente ofídico en las tierras bajas de Guatemala a partir del análisis de 305 expedientes de casos atendidos en los hospitales regionales de Escuintla y San Benito, Petén, entre 2008 y 2013. De los 305 casos, 169 correspondieron al Hospital Regional de Escuintla y 136 al Hospital Regional de San Benito Petén. Los casos del Hospital Regional de Escuintla correspondieron a pacientes provenientes de los departamentos de Escuintla, Santa Rosa, Chimaltenango, Retalhuleu, Suchitepéquez, Sacatepéquez, Sololá y Guatemala. Los casos del Hospital Regional de San Benito Petén correspondieron a pacientes provenientes del área centro y norte de Petén, y algunos referidos del área sur. La edad media de la víctima fue 25.2 años. La enfermedad afectó más a hombres (61.3%) que a mujeres (38.7%). La mayoría de los afectados (28.3%) eran agricultores. Las especies de serpiente que se consignaron en los expedientes con mayor frecuencia fueron Bothrops asper (serpiente barba amarilla) en la región norte y Crotalus simus (serpiente cascabel) en la región sur. La mayoría de las mordeduras ocurrieron en los miembros inferiores. Los eventos de mordedura ocurrieron durante el día y durante la noche en proporciones similares. El tiempo medio que tarda la víctima en llegar al hospital fue de 5.6 horas. Se describen también otros aspectos epidemiológicos y se discuten las implicaciones ecológicas y sociales de los datos generado.

The epidemiological profile of snakebite envenomation in the lowlands of Guatemala is described. The data were generated from the analysis of 305 snakebite envenomation cases treated at Regional Hospitals in Escuintla and San Benito, Petén between years 2008 and 2013. The cases treated at the Regional Hospital of Escuintla occurred in the southern lowlands whereas the cases treated at the Regional Hospital of San Benito Petén occurred in the northern lowlands of Guatemala. The average age of the victim was 25.2 years. Envenomation frequencies were higher for men (61.3%) than for women (38.7%). Farmer was the most involved occupation (28.3%). Bothrops asper (the fer-de-lance snake) was recorded as the main causative of envenomation in the northern lowlands whereas Crotalus simus (the tropical rattlesnake) was the main causative species in the southern lowlands. Most snake bites occurred in the lower limbs of the victim. Envenomation occurred in similar proportions at day or at night. The elapsed time between the envenomation event and the arrival of the victim to the hospital was 5.6 hours. Other epidemiological aspects are also addressed and the ecological and social implications of the data are discussed.

Contribution of ultrasonography to the diagnosis of internal bleeding in snakebite envenomation

Background In Africa, snakebite envenomations are frequently complicated by life-threatening hemorrhagic syndromes. The authors of the present study conducted a prospective analysis at the University Hospital of Parakou (north of Benin) for seven months (January 1 to July 31, 2014) to assess the contribution of ultrasonography to the diagnosis of internal bleedings and management of envenomation. Methods An ultrasound examination was performed in all patients with clinical envenomation regardless of its severity. The study involved 32 patients admitted to the ICU of the University Hospital of Parakou. Results The average age was 27 ± 13.9 years. The main signs of severity were: prolongation of clotting time (88 %), severe anemia (41 %), clinical hemorrhage (47 %), and shock (19 %). The ultrasound imaging showed internal hemorrhage in 18 patients (56 %). There were hematomas (22 %), hemoperitoneum (13 %) or a combination of both (22 %). The occurrence of internal bleeding and hemoperitoneum were mainly related to the delay of hospital presentation (p = 0.007) and the existence of external bleeding (p = 0.04). Thirty patients (94 %) received antivenom. Case fatality rate was 3.1 %. Conclusion Ultrasonography may help in diagnosing internal bleeding, even in patients that did not show external hemorrhages, and evaluating its importance. As a consequence, the management of snakebite victims may be significantly improved.(AU)

Epidemiology of snakebites in Kédougou region (eastern Senegal): comparison of various methods for assessment of incidence and mortality

Background Although considered a public health issue in Senegal, the actual incidence and mortality from snakebite are not known. In the present study, an epidemiological survey was carried out in Kédougou region, southeastern Senegal, where envenomations, particularly by Echisocellatus, are frequent and severe. Methods Three sources of data were used: records from health centers and reports by health professionals; traditional healers; and household surveys. Results The annual incidence and mortality provided by health centers were 24.4 envenomations and 0.24 deaths per 100,000 population, respectively. The annual incidence recorded by traditional healers was 250 bites per 100,000 inhabitants, but the number of deaths was unknown. Finally, the household surveys reported an annual incidence of 92.8 bites per 100,000 inhabitants and an annual mortality rate of 2.2 deaths per 100,000 inhabitants. The differences in incidence and mortality between the different methods were explained by significant bias, resulting in particular from the complex patient's healthcare-seeking behavior. The incidence provided by health records should be used to specify the immediate quantitative requirements of antivenoms and places where they should be available first. Conclusion Mandatory reporting of cases would improve the management of envenomation by simplifying epidemiological surveys. Patients' preference for traditional medicine should prompt health authorities to urge traditional healers to refer patients to health centers according to defined clinical criteria (mainly edema and bleeding or neurotoxic symptoms). Finally, household surveys were likely to reflect the actual epidemiological situation. Poison Control Center of Senegal should continue its work to sensitize stakeholders and train health staff.(AU)

Análise epidemiológica dos acidentes ofídicos no município de teresópolis - rj no período de 2007 a 2010 / Epidemiological analysis of snakebites in Teresópolis - RJ from 2007 to 2010

Objetivo: Determinar a epidemiologia e fluxo de informação de notificação dos acidentes ofídicos no município de Teresópolis (RJ). Métodos: Foi realizado um estudo descritivo, quantitativo e retrospectivo dos acidentes e para isso os dados foram coletados por meio de consulta ao banco de dados SINAN NET e das fichas individuais de investigação para notificação de acidentes por animais peçonhentos do SINAN, emitidas pelo Hospital das Clínicas de Teresópolis Costantino Ottaviano no período de 01/2007 ­ 12/2010. Foram avaliadas as seguintes variáveis: tipo, mês e ano do acidente, município de ocorrência, idade, escolaridade, ocupação, sexo, zona de ocorrência, tempo de atendimento, local da picada, manifestações e complicações locais e sistêmicas, tempo de coagulação, classificação, soroterapia, acidente relacionado ao trabalho e evolução do caso. Resultados: Foram analisadas 121 fichas individuais de investigação do município enquanto no SINAN estão registrados 104 casos, indicando uma subnotificação de 14,4%. O gênero Bothrops aparece como responsável pela maioria dos acidentes atendidos com 81,8% dos casos, apresentando sazonalidade maior nos meses entre outubro e março (72,7%), com predominância de acidentados do sexo masculino (78,5%), idade variando entre 20 e 59 anos (80,2%) e maior acometimento dos membros inferiores (68,8%). Conclusões: Concluiu-se que o perfil dos acidentes segue os padrões já descritos na literatura para a região sudeste, mas que existem falhas no preenchimento das fichas individuais de investigação e falta de sintonia entre o processo de coleta de dados e a apresentação dos dados no sistema SINAN NET, apesar deste ser de extrema importância para a informação sobre acidentes com animais peçonhentos (AU).

Objective: To determine the epidemiology and flow notification information of snakebites in the municipality of Teresópolis (RJ). Methods: We conducted a descriptive study, quantitative and retrospective of accidents and that the data were collected by consulting the SINAN NET database and individual research records for venomous animals by accident notification SINAN issued by the Hospital das Teresópolis Costantino Ottaviano clinics in 01/2007 period - 12/2010. The following variables were evaluated: type, month and year of accident occurrence municipality, age, education, occupation, sex, occurrence area, service time, the bite site, demonstrations and local and systemic complications, clotting time, classification, serum therapy, accident related to work and developments. Results: We analyzed 121 individual records municipal research while in SINAN are recorded 104 cases, indicating underreporting of 14.4%. The Bothrops appears as responsible for most injuries treated with 81.8% of the cases, greater seasonality in the months between October and March (72.7%), with predominance of rough male (78.5%), age ranging from 20 to 59 years (80.2%) and increased involvement of the lower limbs (68.8%). Conclusions: We concluded the accident profile follows the standards described in the literature for the southeast region but there are flaws in the filling of individual forms of research and lack of harmony between the data collection process and presentation of data in the SINAN system NET, although this is extremely important for the information on accidents with poisonous animals (AU).

Acidentes com animais peçonhentos no Brasil por sexo e idade / Accidents with poisonous animals in Brazil by age and sex

INTRODUÇÃO: acidentes com animais peçonhentos são uma emergência clínica frequente em vários países tropicais, principalmente nos campos e áreas rurais, constituindo um problema de Saúde Pública, inclusive pediátricaOBJETIVO: analisar a morbidade, mortalidade e letalidade de acordo com a faixa etária e sexo nos casos de envenenamentos por serpentes, escorpiões e aranhas no BrasilMÉTODO: Os dados sobre envenenamentos por serpentes, escorpiões e aranhas ocorridos no período de 2009 a 2013 foram obtidos na base de dados online do Sistema de Informação de Agravos de Notificação - SINAN do Ministério da SaúdeRESULTADOS: foi registrada uma média de 28.812 casos por ano de acidentes ofídicos, 60.370,8 com escorpiões e 25.786,4 com aranhas. A maioria dos óbitos foi causada por serpentes (119 por ano) e também apresentou maior letalidade (0,41%), seguida por escorpiões (79,6 óbitos) com letalidade de 0,13% e, aranhas (13,2) com menor letalidade (0,05%). Em indivíduos do sexo masculino ocorreram a maioria dos casos de acidentes ofídicos, enquanto que nos acidentes com escorpiões e aranhas foi observado pouca diferença na frequência entre homens e mulheres. A faixa etária com maior número de registros de envenenamentos foi a de 20 a 39 anosCONCLUSÕES: ocorre um aumento progressivo de casos de envenenamentos a partir do primeiro ano de idade até a faixa etária compreendida entre 20 a 39 anos e após esta, começa uma diminuição. Crianças, adolescentes e adultos idosos, constituem grupos mais vulneráveis por apresentarem maiores índices de letalidade, especialmente nos acidentes ofídicos e escorpiônicos.

INTRODUCTION: accidents with poisonous animals are a common clinical emergency in several tropical countries, mainly in the fields and rural areas, constituting a public health problem, including pediatric OBJECTIVE: The objective is to analyze the morbidity, mortality and lethality according to age and sex in cases of poisoning by snakes, scorpions and spiders in Brazil METHODS: data on poisoning by snakes, scorpions and spiders that occurred from 2009 to 2013 were collected in the online database of the Information System on Diseases of Compulsory Declaration (SINAN) of the Ministry of Health RESULTS: were recorded 28.812 cases of snake bites per year, 60.370,8 with scorpions and 25.786,4 with spiders. Most deaths were caused by snakes (119 per year) and also showed higher lethality (0.41%), followed by scorpions (79.6 deaths) with a lethality of 0.13% and spiders (13.2) and the lowest mortality (0.05%). In males individuals were most cases of snake bites, whereas in accidents scorpions and spiders was observed little difference in frequency between men and women. The age group with the largest number of poisonings records was 20-39 years CONCLUSIONS: there is a progressive increase in cases of poisoning from the first year of age until the age range 20-39 years, and after this, begins a decrease in cases. Children, adolescents and elderly adults are most vulnerable because they have higher lethality rates, especially in the snake and scorpion accidents.

Vulnerabilities in snakebites in Sao Paulo, Brazil / Vulnerabilidades aos acidentes ofídicos em São Paulo

ABSTRACT OBJECTIVE To describe elements of vulnerability of victims of snakebite. METHODS This qualitative, descriptive, cross-sectional study had, as theoretical framework, the concept of vulnerability in individual, social, and programmatic dimensions. We interviewed 21 patients admitted into a hospital specialized in the care of accidents caused by venomous animals. The interviews were analyzed according to a discourse analysis technique. RESULTS Patients were mainly young men, living in remote countryside areas, where health services frequently have limited resources. We found social and individual conditions of vulnerability, such as precarious schooling, low professional qualification, housing without access to piped water, no sewage treated, and no regular garbage collection, and lack of knowledge on this health problem. Regarding the programmatic dimension, we found limited accessibility to the health services that could affect the prognosis and the frequency of sequelae and deaths. CONCLUSIONS Considering such vulnerabilities evoke the need to improve the program for control the Accidents by Venomous Animals and the training of health workers, we highlight the potential use of the concept of vulnerability, which may amplify the understanding and the recommendations for the practice and education related to snakebites.

RESUMO OBJETIVO Descrever elementos de vulnerabilidade de vítimas de acidentes por serpentes. MÉTODOS Este estudo qualitativo, descritivo e transversal teve como referencial teórico o conceito de vulnerabilidade, nas dimensões: individual, social e programática. Foram entrevistados 21 pacientes internados em hospital especializado no cuidado a vítimas de acidentes por animais peçonhentos. Os depoimentos foram analisados segundo técnica de análise de discurso. RESULTADOS Os pacientes eram, em sua maioria, homens jovens e residentes em área rural, onde frequentemente os recursos de saúde são limitados. Foram observadas condições de vulnerabilidade individual e social, tais como: escolaridade precária, baixa qualificação profissional, moradia sem acesso à água encanada, esgoto e coleta regular de lixo e precário conhecimento a respeito desse agravo à saúde. Quanto à dimensão programática, verificou-se acessibilidade restrita ao serviço de saúde, que poderia repercutir no prognóstico e na frequência de sequelas e mortes. CONCLUSÕES A constatação de elementos de vulnerabilidade em suas três dimensões evoca a necessidade de melhoria de programa de controle e formação dos trabalhadores de saúde. Destaca-se a potencialidade do uso do conceito de vulnerabilidade, o que pode ampliar a interpretação e recomendações para a prática e ações educativas relacionadas aos acidentes ofídicos.

Epidemiologicalpprofile of snakebite accidents in a metropolitan area of northeast Brazil / Perfil epidemiologico dos acidentes por picada de cobra em regiao metropolitana do nordeste do Brasil

SUMMARY The aim of this study was to describe the epidemiological profile of snakebite accidents reported by the toxicological assistance center in Fortaleza, Ceará, Brazil. Database information on snakebite accidents was analyzed regarding the period from January 2003 to December 2011. A total of 1063 cases were found. The accidents occurred during the rainy months (March, April and May), in urban areas (52.3%), affecting individuals younger than 50 years and predominantly among males (70.7%). The lower limbs were the most frequently affected body area (33.7%). Most accidents involved non-venomous snakes (76.1%). The genus Bothrops was the main one involved in venomous accidents (83%). It is expected that this study can be used as the substrate to improve healthcare surveillance and implementing better measures for the treatment of this population. .

RESUMO O objetivo deste estudo é descrever o perfil epidemiológico dos acidentes ofídicos atendidos e notificados ao Centro de Assistência Toxicológica (CEATOX), em Fortaleza, Ceará, Brasil. Foram analisadas informações sobre os acidentes ofídicos relativos ao período compreendido entre janeiro de 2003 a dezembro de 2011, por meio de banco de dados. Os resultados demonstraram 1063 casos notificados ao CEATOX, Ceará. Os acidentes ocorreram principalmente em meses chuvosos (março, abril e maio), em áreas urbanas (52,3%), em uma faixa etária menor de 50 anos, acometendo predominantemente o sexo masculino (70,7%). Os membros inferiores foram os locais mais afetados (33,7%). A maior parte dos acidentes envolveu serpentes não peçonhentas (76,1%). O gênero Bothrops foi o maior responsável pelos acidentes com serpentes peçonhentas (83%). Espera-se que os dados da casuística obtida sirvam de ferramenta para o planejamento de medidas de saúde voltadas para prevenção e atendimento mais adequado da população em estudo. .

Injuries and envenoming by aquatic animals in fishermen of Coxim and Corumbá municipalities, state of Mato Grosso do Sul, Brazil: identification of the causative agents, clinical aspects and first aid measures / Traumas e envenenamentos por animais aquáticos em pescadores de Coxim e Corumbá, estado de Mato Grosso do Sul, Brasil: identificação de agentes causadores, aspectos clínicos e medidas de primeiros socorros

INTRODUCTION: The fishes of continental Brazil have socioeconomic importance due to their potential for sport fishing and commercial and subsistence uses, as seen in the Upper Paraguay River Basin, particularly in the municipalities of the Pantanal region, where it is the second largest economic activity. Injuries caused in professional fishermen are common and poorly studied, as in other regions of the country. METHODS: Data were obtained from questionnaires and interviews with 100 professional fishermen, 50 in each municipality, between December 2008 and October 2009. RESULTS: All the fishermen reported some kind of injury caused by fish stings (78 percent of injuries) and fish, alligator and snake bites (22 percent) on the hands (46 percent of cases) and feet (35 percent of cases). Most of the patients had mild symptoms. The most severe cases were associated with secondary bacterial infections and required specific treatment and prolonged recovery associated with social and economic losses. CONCLUSIONS: The results of this study indicate that the stressful work conditions, inattention to basic preventive measures and carelessness were factors that contributed to accidents and that the toxicity and ability to inflict mechanical trauma of some aquatic species, plus the ineffective use of first aid and hospital treatment, contributed to the high morbidity and complications in many cases. Data from this study are relevant to the fishing communities of the Pantanal region, since they reveal high rates of accidents, lack of knowledge concerning first aid, initial treatment, injury prevention and lack of medical follow-up of the population.

INTRODUÇÃO: Os peixes continentais do Brasil têm grande importância socioeconômica, tanto pelo potencial para a pesca esportiva, quanto para a pesca comercial e de subsistência, como é notado na bacia do Alto Rio Paraguai, particularmente, nos municípios da região do Pantanal. Ferimentos e envenenamentos em pescadores profissionais são comuns e pouco estudados. MÉTODOS: Foram entrevistados 100 pescadores profissionais, 50 em cada município, entre dezembro/2008 e outubro/2009. RESULTADOS: Todos relataram ter sofrido algum tipo de acidente, sendo estes causados por ferrões de peixes (78 por cento dos acidentados) e mordidas de peixes, jacarés ou serpentes (22 por cento), estes ocorridos em maioria nas mãos (46 por cento dos casos) e pés (35 por cento dos casos). A maioria dos pacientes apresentou sintomas leves. Os casos mais graves apresentavam infecções bacterianas e necessitaram de tratamento específico e tempo prolongado de recuperação, o que condicionou às vítimas prejuízos socioeconômicos. CONCLUSÕES: Os resultados deste estudo indicam que, no plano social, as condições estressantes do trabalho, a desatenção com medidas preventivas básicas e o descuido foram os fatores que mais contribuíram para os acidentes. Por outro lado, a capacidade de algumas espécies de envenenar ou de produzir traumas mecânicos e o emprego de primeiros socorros e tratamentos hospitalares ineficazes contribuíram para a grande morbidade e complicações em muitos casos. Os dados deste estudo são relevantes para as comunidades pesqueiras do Pantanal, uma vez que revelam altos índices de acidentes de trabalho, inexistência de noções de primeiros socorros ou prevenção dos acidentes e ausência de atendimento médico continuado junto a estas populações.

Perfil dos acidentes ofídicos no norte do Estado de Minas Gerais, Brasil / Profile of snakebite accidents in the north of the State of Minas Gerais, Brazil

O objetivo deste estudo foi descrever o perfil epidemiológico dos acidentes ofídicos da macrorregião de saúde do Norte do Estado de Minas Gerais, Brasil. Foram analisadas informações sobre os acidentes ofídicos relativos ao período compreendido entre janeiro de 2002 a dezembro de 2006, por meio de bancos de dados. Os resultados demonstraram 10.553 casos notificados, com ênfase para a maior casuística em meses de tempo quente e chuvoso, em áreas urbanas (54,1 por cento), faixa etária menor de 20 anos (39,7 por cento), acometendo mais homens e estudantes (53,1 por cento e 29,1 por cento) respectivamente. Os membros inferiores (pé, dedo do pé, perna e coxa) foram os locais mais afetados (35,9 por cento), as serpentes prevalentes foram do gênero Bothrops (82,9 por cento) e a gravidade da maioria dos acidentes foi leve (66,2 por cento). Observou-se nesse estudo um importante impacto da sazonalidade, urbanização, subnotificação das espécies envolvidas nesses acidentes e busca rápida pelo pronto atendimento. Espera-se que os dados inéditos da casuística obtida possam servir de substrato para o planejamento e execução de medidas voltadas para vigilância em saúde e atendimento.

The aim of this study was to describe the epidemiological profile of snakebite accidents in the healthcare macroregion of the north of the State of Minas Gerais, Brazil. Database information on snakebite accidents covering the period from January 2002 to December 2006 was analyzed. It was found that 10,553 cases were notified, and that the samples were noticeably larger in the months of hot and rainy weather, in urban areas (54.1 percent), at ages less then 20 years (39.7 percent) and among men and students (53.1 percent and 29.1 percent) respectively. The lower limbs (feet, toes, legs and thighs) were the locations most affected (35.9 percent). The most prevalent snakes were in the genus Bothrops (82.9 percent) and most of the accidents were mild (66.2 percent). In this study, it was seen that the seasonality, urbanization and undernotification of the species involved in these accidents had a notable impact, along with seeking walk-in care. It is expected that the new data obtained from this sample may serve as the substrate for planning and implementing measures for healthcare surveillance.

Perfil epidemiológico de acidentes ofídicos do Estado do Amapá / Epidemiological profile of snake poisoning accidents in the State of Amapá

O presente trabalho apresenta o perfil epidemiológico dos acidentes ofídicos notificados junto à Secretaria do Estado de Saúde do Estado do Amapá. Para isso, foram analisadas 909 fichas durante o período de 2003 a 2006. A maior freqüência de picadas foi no ano de 2004 com registro de 255 casos, seguido pelo ano de 2006 com 246 casos. Os números mais expressivos de pacientes encontram-se nas faixas etárias compreendidas entre 20 e 34 anos (30 por cento). Os gêneros Bothrops e Crotalus foram responsáveis por 67,5 por cento e 0,7 por cento dos acidentes, respectivamente. Serpentes consideradas não peçonhentas causaram 0,2 por cento dos acidentes e em 31,2 por cento dos casos não foi possível a identificação da espécie. Indivíduos do sexo masculino (80,6 por cento) foram os mais atingidos. A maior incidência de picadas foi nos membros inferiores (68 por cento). Os acidentes ocorreram, em sua maioria, na área rural (62,7 por cento), em circunstâncias equilibradas de trabalho (60 por cento) e lazer (15,6 por cento). O tempo decorrido entre a picada e o atendimento ao paciente foi de 12 horas (29 por cento). Dos acidentes ofídicos, 263 foram classificados como leves, 193 graves e 187 moderados.

This study presents the epidemiological profile of snake poisoning accidents notified to the Health Department of the State of Amapá. For this, 909 records over the period from 2003 to 2006 were analyzed. The greatest frequency of bites was in the year 2004, with 255 cases recorded, followed by the year 2006 with 246 cases. The largest numbers of patients were in the age range between 20 and 34 years (30 percent). The genera Bothrops and Crotalus accounted for 67.5 percent and 0.7 percent of the accidents, respectively. Snakes that are considered non-venomous caused 0.2 percent of the accidents, and it was not possible to identify the species in 31.2 percent of the cases. Male individuals were more affected (80.6 percent). The highest incidence of bites was on the lower limbs (68 percent). The accidents mostly occurred in rural areas (62.7 percent), during balanced work circumstances (60 percent) or leisure activities (15.6 percent). The time elapsed from the bite to attending the patient was 12 hours (29 percent). Among the snake poisoning accidents, 263 were classified as mild, 187 as moderate and 193 as serious.

Epidemiological profile of snakebites in Morocco

The present work aims to find the epidemiological profile of snakebites in Morocco through a retrospective study of 1,423 snakebite cases that occurred between 1992 and 2007. Data were obtained from medical charts of envenomation at the Poison Control and Pharmacovigilance Center of Morocco. Results revealed that 86 percent of the snakebites had occurred in rural areas and that males were significantly more affected than females at a sex ratio of 23:20. Furthermore, 35 percent of the bites happened during the summer, with a peak of 215 cases in June (15.1 percent). We also discovered that 67.3 percent of the patients were bitten during the day. The age group that comprised the most agriculturally active persons, from 20 to 44 years old, was the most affected by snakebites (551 cases). In terms of evolution, patients who were at least 60 years of age (8.89 percent) as well as those who were less than 10 years old (7.50 percent) presented higher mortality. According to clinical severity grades, the data revealed a 70 percent predominance of grade 2 cases (430). Deaths had occurred only in patients with grades 3 and 4. Furthermore, grade 4 patients presented 100 percent mortality whereas grade 3 registered 10.7 percent. The distribution of snakebites according to administrative regions in Morocco showed a predominance of the Souss-Massa-Daraa region both in terms of frequency (32 percent) and mortality (72.1 percent). Our study clearly displayed the severity and extent of the snakebite problem in the country, thus revealing that public health authorities should give more attention to this serious situation.(AU)

Envenenamento por serpentes do gênero Bothrops no Estado da Bahia: aspectos epidemiológicos e clínicos / Envenomation by Bothrops in the State of Bahia: epidemiological and clinical aspects

Descreve-se características clínico-epidemiológicas de 655 casos de acidentes botrópicos atendidos e/ou notificados ao Centro de Informações Antiveneno da Bahia, no Estado da Bahia, em 2001. A incidência anual no Estado foi de 5,0 acidentes/100.000 habitantes e a letalidade, 1 por cento. A incidência foi máxima na microrregião Litoral Norte (21,9/100.000 habitantes) e no município de Itanagra (92,9/100.000 habitantes). Os acidentes foram predominantemente diurnos, acometendo membros inferiores, em homens, de 11-30 anos, trabalhadores, no ambiente rural e no período chuvoso. Atendimento médico após 13 horas da ocorrência da picada ocorreu em 19 por cento dos casos. Predominaram os quadros clínicos moderados (47,8 por cento), seguidos dos graves (23,6 por cento). As manifestações clínicas locais e sistêmicas seguiram o padrão nacional para as serpentes do gênero Bothrops. Sintomatologias neurológicas, não usualmente atribuídas ao acidente botrópico, foram registrados em alguns casos. A soroterapia empregada (7,7 ampolas/paciente) foi compatível com o fato da maioria de casos serem moderados. Outros tipos de soro que não o univalente foram utilizados em 15 (2,3 por cento) pacientes.

This study describes the clinical and epidemiological characteristics of 655 cases of Bothrops snakebites that were attended by and/or notified to the Bahia Antivenin Information Center, State of Bahia, Brazil, in 2001. The annual incidence in the State was 5.0 cases/100,000 inhabitants and lethality was 1 percent. The incidence was greatest in the North Coast microregion (21.9/100,000 inhabitants) and the municipality of Itanagra (92.9/100,000 inhabitants). The snakebites occurred predominantly during the day, affecting the lower limbs of men aged 11-30 years who worked in rural areas during the rainy period. Medical care was obtained more than 13 hours after the snakebite in 19 percent of the cases. Moderate (47.8 percent) and severe (23.6 percent) clinical presentations prevailed. The local and systemic clinical manifestations followed the usual pattern for Bothrops snakebites in Brazil. However, a few cases presented neurological manifestations, which are not usually attributed to Bothrops snakebites. The antivenin therapy used (7.7 blisters/patient) reflected the fact that the majority of the cases were moderate. Antivenins other than the univalent type were used in 2.3 percent of the cases.

Características clínicoepidemiológicas dos acidentes ofídicos em Rio Branco, Acre / Clinical and epidemiological characteristics of snakebites in Rio Branco, Acre

Com o objetivo de determinar o perfil clínico-epidemiológico dos acidentes ofídicos, em hospital do Estado do Acre, foram estudados prospectivamente 144 pacientes admitidos no período de janeiro a dezembro de 2002. Desses, 113 (78,5 por cento) foram classificados como vítimas de acidente com envenenamento. Os gêneros Bothrops, Lachesis e Micrurus foram responsáveis por, respectivamente, 75,7 por cento, 2,1 por cento e 0,7 por cento dos casos. Os acidentes predominaram em pessoas do sexo masculino (78,5 por cento), trabalhadores rurais (51,4 por cento) e com idades entre 10 e 29 anos (43,8 por cento). Nos acidentes botrópicos, os envenenamentos considerados moderados (48,6 por cento) prevaleceram sobre os leves (31,2 por cento) e graves (20,2 por cento). Dois casos envolvendo o gênero Bothrops não receberam terapia antipeçonha. Entretanto, soro heterólogo foi administrado em 23 vítimas de acidente sem envenenamento. Concluindo, os resultados obtidos neste estudo diferiram dos observados por outros autores quanto à gravidade dos casos e adequação do tratamento, indicando a necessidade de treinamento da equipe.

Situación epidemiológica de la enfermedad diarreica agudad(EDA) en Nicaragua / Epidemiological situation of the disease diarreica acute (EDA) in Nicaragua

Presenta boletín epidemiológico de la semana 09, del 27 de febrero al 5 de marzo del 2005. Aborda la situación epidemiológica de la enfermedad diarreica agudad(EDA) en Nicaragua. Se ha registrado durante el año 2005 de la semana 1 al 9 para un total de 42, 986 lo que comparado con el año anterior (34,607) significa un incremento del 24 porciento (8,379) casos más que igual período del año anterior. Durante las semanas 1 a la 5, el comportamiento fue bastante estable, registrándose un promedio de 3,576 casos semanales. Entre los factores que han contribuido a la deshidratación severa y la muerte de los niños encontramos la demora en la búsqueda de la atención médica, demora en el inicio de la rehidratación oral, automedicación y en especial la práctica de pugar al niño por sus familiares. Hasta la semana No. 9 se han registrado un total de 39 muertes por diarrea lo que representa un incremento del 95 porciento (19 muertes más. En los SILAIS que se registraron mayores tasas de mortalidad son: Madriz, Granada, RAAS, Nuea Segovia, León , Jinotega y Estelí en relación al media nacional (0.7 x 100,000 hab) 5 (29 porciento) SILAIS se encentran por debajo, siendo éstos Chinandega, Managua, Matagalpa, RAAN y Masaya. Tambien se incluyen medidas que deben tomar la población para evitar las diarreas en los niños menores de cinco años, asimismo medidas a tomar por el personal de salud que atiende a estos niños

Envenomation by neotropical Opisthoglyphous colubrid Thamnodynastes cf. pallidus Linné, 1758 (Serpentes: Colubridae) in Venezuela

Se reporta un caso de una mordedura de serpiente "no venenosa", en un herpetólogo observado en la Facultad de Ciencias de la Universidad de los Andes (Mérida, Venezuela). El paciente fue mordido en el dedo medio de la mano izquierda, mostrando pronunciados signos locales de sangramiento por la impronta ocasionada por los dientes de la serpiente, edema y calor local. El paciente fue tratado con cuidados locales, analgésicos y esteroides. Fue dado de alta del hospital y observado en el hogar durante 5 días, con marcada mejoría del envenenamiento. La serpiente fue traída a la consulta médica e identificada como un espécimen de Thamnodynastes cf. pallidus. Este es el primer caso humano descrito, ocasionado por un T. pallidus.