Acidentes por animais peçonhentos no Estado do Tocantins: aspectos clínico-epidemiológicos

Acidentes por animais peçonhentos são a segunda causa de envenenamento humano no Brasil, atrás apenas da intoxicação por medicamentos. Nacionalmente os escorpiões são os maiores responsáveis por esse evento, mas existe variação regional conforme os diferentes graus de ocupação humana e hábitat dos animais envolvidos. Este trabalho estudou os acidentes por animais peçonhentos no Estado do Tocantins nos anos de 2010 e 2011, com o objetivo de identificar aspectos clínico-epidemiológicos relacionados a esse agravo. Os dados foram levantados a partir do Sistema de Informação de Agravos de Notificação (SINAN) e relacionados às características pluviométricas da região. Utilizou-se o software BioEstat 5.0® para verificar a validade estatística dos dados através do teste de qui-quadrado, definido um α=5%. Das vítimas, 69,0% eram do sexo masculino e 50,0% tinham idade entre 20 e 49 anos. A maioria dos acidentes ocorreu no período de chuvas e na zona rural (58,9%), ambiente onde os homens foram três vezes mais acometidos que as mulheres. A picada foi mais frequente no pé (40,5%), mão (15,7%) e perna (12,2%), demonstrando que o uso de calçados apropriados, luvas e perneiras pode representar importante medida de proteção. As serpentes causaram a maioria dos acidentes (50,9%), seguidas dos escorpiões (19,7%). Dor e edema foram as principais manifestações clínicas locais relatadas, e infecção secundária a complicação local mais frequente. Dez óbitos foram registrados no período, todos por picada de serpentes. Tais dados mostram que as principais vítimas desses acidentes no Estado são homens jovens procedentes da zona rural, acometidos nas extremidades corporais, especialmente no período de chuvas. Palavras-chave: envenenamento; picada; epidemiologia. ABSTRACT Accidents by venomous animals are the second cause of human poisoning in Brazil, second only to drug intoxication. Nationally the scorpions are most responsible for this event, but there is regional variation according to different degrees of human occupation and habitat of the animals involved. This study examined the envenomations in Tocantins State in the years 2010 and 2011, with the aim of identifying clinical and epidemiological aspects related to this condition. The data were collected from the Notifiable Diseases Information System (SINAN) and related to rainfall characteristics of the region. It was used the BioEstat 5.0® software to check the statistical validity of the data by the chi-square test, defined an α = 5%. Of all the victims, 69.0% were male and 50.0% were aged between 20 and 49 years. Most accidents occurred during the rainy season and in the countryside (58.9%), environment where men were three times more affected than women. The bite was most frequent in the foot (40.5%), hand (15.7%) and leg (12.2%), demonstrating that the use of proper footwear, gloves and leggings may represent important protective measure. Snakes caused the most injuries (50.9%), followed by scorpions (19.7%). Pain and swelling were the main local clinical manifestations reported, and secondary infection the most frequent local complication. Ten deaths were recorded in the period, all by the bite of serpents. These data show that the main victims of such accidents in the State are young men coming from rural areas, hit in the body’s extremities, especially during the rainy season. Keywords: poisoning; bite; epidemiolog

Ofidismo no Tocantins: análise ecológica de determinantes e áreas de risco, 2007-2015

Objective. To investigate the epidemiological profile affected by snakebite, their determinants and risk areas, in the state of Tocantins. Methods. Ecological study with data from the Notifiable Disease Information System, from 2007 to 2015. Linear regression of tests and Mann-Whitney and Kruskal-Wallis tests were used. Results. 7,764 snakebite were reported (incidence: 62.1/100,000 inhab.; lethality: 0.5%). The variables associated with snakebite were demographic density (Coeff.=1.36, 95%CI 0.72;1.99), agricultural work (Coeff.=0.02, 95%CI 0.01;0.03), Index of Municipal Human Development (Coeff.=2.99 – 95%CI 0.60;5.38), cassava cultivated area (Coeff.=8.49 – 95%CI 1.66;15.32), indigenous population (Coeff.=0,02 – 95%CI 0.00; 0.04), proportion of the illiterate population (Coeff.=4.70 – 95%CI 0.61;8.79) and employed (Coeff.=3.00 – 95%CI 0.93;5,06), which explained 64.48% of the variation. The high-risk areas were Amor Perfect, Cantão, Cerrado Tocantins Araguaia and Middle North Araguaia health regions. Conclusion. Municipal socioeconomic and demographic aspects associated with snakebites.Objetivo. Investigar o perfil dos casos de acidentes ofídicos, seus determinantes e áreas de risco no estado do Tocantins. Métodos. Estudo ecológico, com dados do Sistema de Informação de Agravo de Notificação do período 2007-2015. Empregou-se regressão linear múltipla e os testes Mann-Whitney e Kruskal-Wallis. Resultados. Foram notificados 7.764 acidentes ofídicos (incidência de 62,1/100 mil habitantes; letalidade de 0,5%). As variáveis associadas ao ofidismo foram densidade demográfica (Coef.=1,36 – IC95%0,72;1,99), trabalho agropecuário (Coef.=0,02 – IC95%0,01;0,03), índice de desenvolvimento humano municipal (Coef.=2,99 – IC95%0,60;5,38), área cultivada de mandioca (Coef.=8,49 – IC95%1,66;15,32), população indígena (Coef.=0,02 – IC95%0,00;0,04), proporção de população analfabeta (Coef.=4,70 – IC95%0,61;8,79) e população empregada (Coef.=3,00 – IC95%0,93;5,06), que explicaram 64,48% da variação. As áreas de alto risco foram as regiões de saúde Amor Perfeito, Cantão, Cerrado Tocantins Araguaia e Médio Norte Araguaia. Conclusão. Aspectos socioeconômicos e demográficos municipais associaram-se ao ofidismo

Estudo retrospectivo dos acidentes por serpentes atendidos no Hospital Geral de Palmas-TO, no período de 2010 e 2011.

Os acidentes ofídicos representam um sério problema de saúde pública no Brasil, assim como em outros países de região tropical. A expansão e o crescimento desordenado das cidades acarretam inúmeros impactos como perdas de habitat, predação, falta de abrigo e disponibilidades de recursos. Esses impactos promovem o deslocamento dos diferentes elementos faunísticos para áreas de zona urbana e periurbana, provocando um aumento nos acidentes provocados por serpentes. No Tocantins, são poucos os estudos que avaliam a epidemiologia destes acidentes, sendo este necessário para estabelecer uma conduta adequada para tratamento dos pacientes acometidos por serpentes. Assim, este trabalho teve como objetivo avaliar o perfil dos acidentes por serpentes atendidos no Hospital Geral de Palmas – Tocantins (HGP), nos anos de 2010 e 2011, e elencar as possíveis dificuldades no seu tratamento através da análise dos dados do SINAN e dos prontuários dos pacientes. Nos anos de 2010 e 2011 foram atendidos no HGP 52 pacientes vítimas de acidentes ofídicos. Os acidentes ocorreram em sua maioria com pessoas do sexo masculino, na zona rural, com idade entre 20 a 49 anos, sendo a maioria dos acidentes ocasionados pelo gênero Bothrops. A ocorrência de acidentes com este grupo da população tem sido referida em todas as casuísticas nacionais, o que se deve as atividades do campo, executadas preferencialmente por homens. Portanto, faz se necessário promover ações junto aos moradores das áreas urbanas e rurais para promover medidas que possam reduzir os índices de acidentes com serpentes no município.Palavras chave: Acidente Ofídico, Serpentes, Tocantins.ABSTRACTThe snakebites represent a serious public health problem in Brazil, as well as in other countries of tropical region. The expansion and disordered growth of cities are leading in numerous impacts like loss of habitats, predation, lack of shelter and availability of resources. These impacts promote displacement of different faunal elements for urban areas and peri-urban areas, thus causing an increase in accidents caused by serpents. In Tocantins, there are few studies that assess the epidemiology of these accidents, which is necessary to establish an appropriate conduct for treatment of patients affected by serpents. This work aimed to evaluate the profile of accidents by snakes served in General Hospital of Palmas (GHP) -Tocantins, in the years 2010 and 2011, and list the possible difficulties in its treatment through analysis of data from SINAN and analysis of medical records of patients. In the years 2010 and 2011 were treated in 52 patients HGP victims of snake bites. These Snakebites occurred mostly in males, in rural areas, aged 20-49 years, with the majority of accidents caused by Bothrops. The occurrence of accidents with this group has been referred to in all the studies, national this is field activities in the vast majority being performed by men thus causing a high frequency of accidents with the group. So there is a need to promote actions with the residents of urban and rural areas. These measures can reduce their accident rates with snakes.Keywords: Accident Ophidian, Snakes, Tocantins.

Optimization of the Effects of Different Temperatures and Compositions of Filmogenic Solution on Lactobacillus salivarius Using Predictive Mathematical Models

It is well known that intake of probiotic brings health benefits. Lactic bacteria with probiotic potential have aroused the interest of the industry in developing food products that incorporate such benefits. However, incorporating probiotic bacteria into food is a challenge for the industry, given the sensitivity of probiotic cultures to process conditions. Therefore, the objective of this study is to evaluate gelatin- and inulin-based filmogenic solutions as a potential vehicle for incorporating probiotics into food products and to model the fermentation kinetics. L. salivarius (Lactobacillus salivarius) growth in filmogenic solutions was analyzed under the influence of a variety gelatin concentrations (1.0–3.0%) and inulin concentrations (4.0–6.0%) and fermented under the effect of different temperatures (25–45 °C). A full 23 factorial plan with three replicates at the central point was used to optimize the process. The impacts of process conditions on cell development are fundamental to optimize the process and make it applicable by the industry. The present study showed that the optimal conditions for the development of probiotic cells in filmogenic solutions are a combination of 1.0% gelatin with 4.0% inulin and fermentation temperature of 45 °C. It was observed that the maximum cell growth occurred in an estimated time of about 4 h of fermentation. L. salivarius cell production and substrate consumption during the fermentation of the filmogenic solution were well simulated by a model proposed in this article, with coefficients of determination of 0.981 (cell growth) and 0.991 (substrate consumption)

Vorapaxar in the secondary prevention of atherothrombotic events

Item does not contain fulltextBACKGROUND: Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1. METHODS: We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage. RESULTS: At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or recurrent ischemia leading to revascularization occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P=0.001). Moderate or severe bleeding occurred in 4.2% of patients who received vorapaxar and 2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group; P<0.001). CONCLUSIONS: Inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy. However, it increased the risk of moderate or severe bleeding, including intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 ClinicalTrials.gov number, NCT00526474.)