A retrospective study of clinical and epidemiological characteristics of snakebite in Napo Province, Ecuadorian Amazon.

BACKGROUND: Snakebite envenoming remains a relevant public health problem in tropical and subtropical countries. In Ecuador, this is particularly true in an area of great diversity like the Amazon region. Nevertheless, there is scarce information about epidemiological and clinical characteristics of these accidents in this area. METHODS: This was a descriptive and retrospective study of snakebite cases treated at a tertiary hospital in the Napo Province, Ecuadorian Amazon, from 2015 to 2019. We collected sociodemographic and snakebite-related information, clinical aspects and the use of antivenom and antibiotics from medical records. RESULTS: Information from 133 snakebite accidents was reviewed in this time period. Reports of snakebite envenoming decreased over the years. In total, 67% of those bitten were from nearby indigenous communities, which were the most affected groups. When a species was identified, Bothrops atrox was responsible for the highest number of cases registered. Local clinical manifestations were more frequent than systemic signs, in keeping with the typical effects produced by bothropic venoms. Additionally, data showed that more antivenom vials were given than those suggested by the protocol of the Ecuadorian Ministry of Health, in proportion to the grade of severity. Finally, we identified a low incidence of adverse reactions with antivenom administration, as well as a frequent use of antibiotics. CONCLUSIONS: The profile of snakebite accidents in the Napo Province is very similar to that described for other localities in the Amazon region of Ecuador and neighboring countries, with its challenges and limitations. Such aspects underlie the importance of establishing a robust and science-based public health program to respond to this frequent, but neglected, tropical disease.

Lesión traumática de la arteria carótida por impacto contra un cable atravesado en el camino / Traumatic injury of the carotid artery by impact with a wire across the road

Las lesiones contusas de la arteria carótida tienen el potencial de provocar graves complicaciones neurológicas debido a eventos cerebrovasculares isquémicos. Presentación del caso Un paciente masculino de 41 años sufrió un trauma en el cuello, luego de impactar contra un cable atravesado en la vía pública, mientras conducía una motocicleta. El paciente desarrolló un hematoma expansivo en el cuello pero no presentó alteraciones neurológicas. La puntuación de la escala de coma de Glasgow fue 15/15. Ante la sospecha de una lesión de la arteria carótida se realizó angiotomografía contrastada que demostró una lesión de la íntima carotidea. El manejo quirúrgico incluyó trombectomía in-situ y arteriorrafa. Conclusión La lesión traumática de la arteria carótida es una condición poco común que requiere una alta sospecha clínica para su diagnóstico. El manejo comprende resolución quirúrgica y anticoagulación para prevenir complicaciones de orden neurológico.

Blunt carotid arterial injuries have the potential for cause severe neurological complications due to stroke Case Report A 41 year old male patient suffered a neck trauma by an impact with a wire across the road, while he was driving a motorcycle. The patient developed an expansive hematoma in the neck but do not showed neurological disorders. The score of the Glasgow coma scale was 15/15. Suspecting an injury in the carotid artery a CT angiography with contrast was performed which showed a carotid damage. Surgical management included thrombectomy and suture of the artery. Conclusion Traumatic injury to the carotid artery is a rare condition that requires a high clinical suspicion for diagnosis. Treatment consists in an adequate surgical procedure and anticoagulation to prevent neurological complications.