Acidentes por animais ofídicos: repercussões sistêmicas e prognóstico

Introdução: Os acidentes por animais peçonhentos são um problema mundial, principalmente em países com regiões tropicais e subtropicais, com alto índice de morbidade e mortalidade. No Brasil, há quatro tipos de acidentes ofídicos de interesse em saúde: botrópico, crotálico, laquético e elapídico. O acidente botrópico, mais comum no país, é causado por serpentes dos gêneros Bothrops e Bothrocophias. O acidente é causado pelas cascavéis, as quais são identificadas pela presença de chocalho. Já o acidente laquêtico é causado pela surucucu, maior serpente peçonhenta do Brasil. São manifestações clínicas frequentes, de caráter precoce e progressivo a dor e o edema, podendo ocorrer também bolhas e sangramentos no local da picada. Em casos mais graves pode acontecer necrose de tecidos com formação de abscessos e desenvolvimento de síndrome compartimental. Também pode ocorrer náuseas, vômitos, sudorese, hipotensão arterial e, mais raramente, choque, insuficiência renal aguda, septicemia e coagulação intravascular disseminada. O tratamento efetivo utilizado para neutralizar os envenenamentos é a administração de soroterapia específica. Já a terapêutica geral inclui hidratação, mantendo-se o fluxo urinário de 1 a 2 mL/kg/hora na criança e 30 a 40 mL/hora no adulto, com o auxílio, se necessário, de manitol e diuréticos de alça por via intravenosa. Deve-se orientar a vacinação contra tétano, devido ao risco de introdução de esporos da bactéria Clostridium tetani no local da ferida. O presente estudo objetivou avaliar as repercussões sistêmicas dos diferentes tipos de veneno, o manejo adequado e o prognóstico. Metodologia: revisão integrativa da literatura, nas bases de dados Pubmed, e Scielo, com os descritores: “Animais Peçonhentos”, “Mordedura de Serpentes” e “Snake Venoms”. Foram utilizados 11 artigos, com data de publicação entre 2014 e 2021.  Desenvolvimento: As serpentes do grupo botrópico, como a jararaca e a cascavel, são responsáveis pela maioria dos acidentes ofídicos no país. Seus venenos contêm proteases e fosfolipases A2, que causam danos locais significativos, como inflamação, hemorragia, edema, dor e necrose. Além disso, podem ocorrer sintomas sistêmicos, como sangramentos na pele e mucosas, hipotensão e insuficiência renal aguda. O tratamento é realizado com o soro antibotrópico ou soro botrópico-laquético, que neutraliza os efeitos tóxicos do veneno. Os animais do grupo laquético apresentam venenos semelhantes aos botrópicos e manifestações clínicas parecidas. No entanto, sintomas vagais, como náuseas, vômitos e hipotensão, são mais comuns nos acidentes laquéticos, permitindo a diferenciação clínica. O tratamento também é realizado com o soro antibotrópico-laquético. As serpentes cortálicas, como a cascavel, possuem venenos com alta concentração de proteínas de alto peso molecular, como enzimas e peptídeos. Os sintomas locais, como dor, edema e parestesia, são geralmente discretos. No entanto, o veneno é principalmente neurotóxico, causando paralisia por bloqueio da transmissão neuromuscular. Também podem ocorrer efeitos proteolíticos e hemorrágicos. A insuficiência renal é uma complicação grave. O tratamento envolve o uso do soro anticrotálico. As serpentes elapídicas, como a Naja, possuem venenos primariamente neurotóxicos. Eles interferem na transmissão de impulsos nervosos, levando à paralisia, problemas respiratórios e, em casos graves, asfixia. O veneno elapídico também pode ter efeitos cardiotóxicos, causando arritmias e insuficiência cardíaca. Os sintomas locais geralmente são discretos. O tratamento é realizado com o soro antielapídico. É fundamental ressaltar que a gravidade dos acidentes com serpentes pode variar de acordo com a espécie, quantidade de veneno injetado, local da mordida e estado de saúde do indivíduo. O tratamento precoce com soroterapia específica é essencial para neutralizar os efeitos do veneno. Além disso, medidas de suporte, como hidratação adequada e administração de analgésicos, são importantes para o manejo dos pacientes. Conclusão: Em resumo, os acidentes com serpentes no Brasil são um problema de saúde pública que requer uma abordagem multidisciplinar. O diagnóstico e tratamento precoces, com o uso de soros específicos, são essenciais para reduzir complicações e aumentar as chances de recuperação. Além disso, medidas de suporte e a conscientização da população sobre serpentes peçonhentas são importantes para prevenir acidentes. A educação contínua e a promoção de medidas preventivas são fundamentais para reduzir o impacto desses acidentes na saúde pública

Ethics, health and nursing moral dilemmas and the impact on health care: a report of experience.

The experience aimed at implementing the discussion about ethics and bioethics with the population, stimulating the thinking of the moral issues in life. This is an experience report from the “I ethical, health and nursing fair: moral dilemmas and the impact on health care", with the target audience formed by undergraduate students in nursing and the public community of the public square, held in May 19th, 2016. It was productive and important for life at college, as well as for academic outcomes, because, since then, it started showing us a broader view of the practical reality within our theoretical discussions, as well as it was perceived the importance of improving the knowledge of all of those who visited us that day and contributed to the dissemination of knowledge.A experiência teve como objetivo implementar a discussão sobre ética e bioética com a população, estimulando o pensar das questões morais da vida. Trata-se de um relato de experiência da “I amostra ética, saúde e enfermagem: dilemas morais e o impacto na assistência à saúde” tendo como público alvo os discentes do curso de graduação em enfermagem e a comunidade visitante da praça pública, realizada em 19 de maio de 2016. Foi produtivo e importante para a formação e desenvolvimento acadêmico, pois, a partir de então, passou-se a ter uma visão mais ampla da realidade prática de nossas discussões teóricas, bem como percebeu-se a importância do aprimoramento do conhecimento de todos que nos visitaram naquele dia e contribuíram para a disseminação do saber

Antioxidant, antimicrobial and immunostimulant properties of saline extract from Caesalpinia pulcherrima (L.) Swartz (Fabaceae) leaves

281-289Caesalpinia pulcherrima (L.) Swartz is a species that originates in India and Central America and is widely distributed in the world. This plant presents important biological properties, due to the presence of some secondary medicinal metabolites, such as tannins, glycosides, flavonoids and diterpenes. In folk medicine, C. pulcherrima is used in different diseases as bronchitis, asthma, infections, wounds and eye irritations. The aim of this study was to perform a phytochemical screening and evaluate which biological properties the saline extract of leaves from C. pulcherrima have against microorganisms and animal cells. Results showed that 15 majority compounds could be found in saline extract distributed among phenol, coumarin and quercetin groups.Saline extract of leaves from C. pulcherrima also showed good results in antioxidant test and showed significant antifungal property against Candida strains. Moreover, the saline extract did not showed cytotoxicity against mice splenocytes and promoted proliferation in these cells. These results may be predictive for future studies using the saline extract from C. pulcherrima leaves as cell stimulant agent in a pharmaceutical phytotherapic formulation used in cicatricial and in vitro immunostimulant assays

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Conocarpus erectus L., a plant with a high content of structural sugars, ions and phenolic compounds, shows antioxidant and antimicrobial properties promoted by different organic fractions

Objective: To evaluate the structural and chemical composition of plant and the antioxidant and antimicrobial activities promoted by hexanic, ethanolic and ethyl acetate fractions obtained from leaves of Conocarpus erectus. Methods: Organic fractions were characterized through UPLC-MS and GC-MS. Antioxidant potential was performed through DPPH and molybdenum phosphate techniques. Antibacterial and antifungal assays were performed in accordance with Clinical and Laboratory Standards Institute protocols. Results: The obtained biomass of Conocarpus erectus leaves showed the high presence of glucose (0.45 g/L), cellulose (28.69%), Na (55.126 μg/L) and K (31.163 μg/L). We identified seven compounds in the hexanic and ethyl acetate fractions, and eight compounds in ethanolic fraction. Moreover, phenolic compounds are prevalent in all organic fractions with values of (10.04 ± 0.24), (221.26 ± 1.84), (340.53 ± 0.84) mg/g GAE to hexanic, ethyl acetate and ethanolic fraction, respectively. Antioxidant results showed a high potential in ethyl acetate fraction (71.82 ± 6.87)% and (10.89 ± 0.05)% in DPPH and molybdenum phosphate techniques, respectively. The ethanolic fraction showed moderate bacteriostatic and bactericidal activity against Staphylococcus aureus and presented a high fungistatic potential for all Candida species tested. Conclusions: Organic fractions obtained from leaves of Conocarpus erectus present antimicrobial and antioxidant properties, and these findings contribute to scientific information for the effectiveness on use of this plant in the development of a phytotherapic compound

Clinical characteristics and outcomes of hospital-manifested COVID-19 among Brazilians

ABSTRACT: Objectives: To analyze the clinical characteristics and outcomes of admitted patients with the hospital- versus community-manifested COVID-19 and to evaluate the risk factors related to mortality in the first population. Methods: This retrospective cohort included consecutive adult patients with COVID-19, hospitalized between March and September 2020. The demographic data, clinical characteristics, and outcomes were extracted from medical records. Patients with hospital-manifested COVID-19 (study group) and those with community-manifested COVID-19 (control group) were matched by the propensity score model. Logistic regression models were used to verify the risk factors for mortality in the study group. Results: Among 7,710 hospitalized patients who had COVID-19, 7.2% developed symptoms while admitted for other reasons. Patients with hospital-manifested COVID-19 had a higher prevalence of cancer (19.2% vs 10.8%) and alcoholism (8.8% vs 2.8%) than patients with community-manifested COVID-19 and also had a higher rate of intensive care unit requirement (45.1% vs 35.2%), sepsis (23.8% vs 14.5%), and death (35.8% vs 22.5%) (P <0.05 for all). The factors independently associated with increased mortality in the study group were increasing age, male sex, number of comorbidities, and cancer. Conclusion: Hospital-manifested COVID-19 was associated with increased mortality. Increasing age, male sex, number of comorbidities, and cancer were independent predictors of mortality among those with hospital-manifested COVID-19 disease