Descrição de injúria humana causada por falsa tocandira (Dinoponera gigantea, Perty, 1833) com revisão dos aspectos folclóricos, farmacológicos e clínicos das formigas gigantes do gênero Paraponera e Dinoponera (sub-família Ponerinae)

A partir de um acidente causado pela picada de uma formiga falsa tocandira na mão de um pescador amador, os autores descrevem os achados clínicos locais observados, tais como edema, eritema e dor excruciante e a evolução do envenenamento, que cursou com fenômenos sistêmicos imediatos, como sudorese fria, náuseas, vômitos, mal estar, taquicardia e linfadenopatia axilar à esquerda. Após três horas, a dor intensa persistia e o paciente apresentou um episódio de hematoquesia, sem história anterior de enfermidades do trato digestivo, hematológicas ou vasculares. O uso de analgésicos (Tramal® 300 mg/dia), água quente e gelo não melhorou a dor, que arrefeceu em oito horas, tendo permanecido por cerca de 24 horas. São apresentados ainda os aspectos folclóricos, farmacológicos e clínicos relacionados às picadas de tocandiras.The authors observed an injury caused by the sting of a false tocandira ant in the hand of an amateur fisherman and they describe the clinical findings and the evolution of the envenoming, which presented an acute and violent pain, cold sweating, nausea, a vomiting episode, malaise, tachycardia and left axillary's lymphadenopathy. About three hours after the accident, still feeling intense pain in the place of the sting, he presented an episode of great amount of blood in the feces with no history of digestive, hematological or vascular problems. The intense pain decreased after eight hours, but the place stayed moderately painful for about 24 hours. In that moment, he presented small grade of local edema and erythema. The authors still present the folkloric, pharmacological and clinical aspects related to the tocandiras stings, a very interesting family of ants, which presents the largest and more venomous ants of the world

MIÍASE FURUNCULAR: Relato de caso / MIÍASE FURUNCULAR: Case Study

A Miíase é uma doença causada pela penetração de larvas de moscas em órgãos ou tecidos dos seres humanos ou de outros animais vertebrados. Elas se desenvolvem alimentando de tecidos vivos ou mortos dependendo da espécie. A infestação do hospedeiro ocorre quando larvas de dípteros penetram no tecido ou nas cavidades naturais do corpo e depositam seus ovos. Ocorrem em países de clima tropical, principalmente em zonas rurais. Atinge qualquer faixa etária, sendo mais comum em idosos de ambos os sexos, pacientes que possuem algum transtorno mental, higiene precária, morador de rua, paciente entubado, respirador bucal, diabético, baixo grau de instrução, embora possa acometer indivíduos saudáveis. As manifestações clínicas podem ser variadas dependendo do sítio, podendo ser cutânea, subcutânea (ou de órgãos internos), cavitárias, oculares e palpebrais. O paciente pode apresentar sintomas como mialgia, febre, odor acentuado e perceber a presença das larvas pela movimentação dentro de seu próprio corpo e pela liberação de exsudato. O tratamento convencional para a doença é a remoção mecânica e cirúrgica das larvas. O objetivo deste trabalho foi relatar um caso clínico de miíase bucal em paciente do sexo feminino, de 40 anos de idade que não apresentava alterações sistêmicas

Hemostatic disorders induced by skin contact with Lonomia obliqua (Lepidoptera, Saturniidae) caterpillars

Patients envenomed by Lonomia sp caterpillars initially experience a mild burning pain, headache, nausea, vomiting, and skin and mucosal hemorrhages. Some patients can rapidly progress to a severe coagulopathy that presents as visceral or intracerebral hemorrhaging. We studied the hemostatic alterations that occurred in 14 patients who were envenomed by Lonomia obliqua in Southern Brazil and presented at the Hospital São Vicente de Paulo (Passo Fundo, RS), Brazil during the summers of 1993 and 1994 when Lonomia antivenom was not yet available for treatment. The patients were classified into to 4 clinical groups: 0 (two patients), I (eight patients), II (two patients), and III (two patients). The patients were admitted to the hospital between 4 hours and five days after contact with the caterpillars. In this study, the coagulation parameters of the patients were followed up for up to 172 hours after the accidents. The patients received no treatment with the exceptions of two patients who received blood transfusions and antifibrinolytic treatment. The observed abnormalities related to blood coagulation and fibrinolytic factors were similar regardless of the severity of the bleeding symptoms. These findings suggest that alterations in hemostatic parameters without thrombocytopenia are not predictors of the seriousness of such accidents. Thus, consumptive disorder and reactive fibrinolysis are not proportional to mild coagulopathy. Furthermore, these patients recovered. The hemostatic parameters of most of the patients normalized between 96 and 120 h after the accident

Epidemic outbreaks of dermatitis caused by Hylesia (Lepidoptera: Hemileucidae), in S. Paulo State, Brazil

Surtos epidêmicos de dermatite causada por Hylesia sp foram assinalados no litoral do Estado de São Paulo, no período de dezembro de 1989 a dezembro de 1991. O fenômeno assumiu sua maior intensidade em Bertioga, Município de Santos, onde foram registrados 612 casos. Foram atingidos outros 12 municípios da região, estimando-se que algumas centenas de casos procuraram os serviços de saúde locais. Na maioria dos casos verificou-se lesões eritemato-pápulo-pruriginosas, que regrediram em média de 7 a 14 dias. Para tratamento foram utilizados anti-histamímicos sistêmicos corticosteróides tópicos e compressas frias. Ocorreram três episódios epidêmicos no período citado, todos eles coincidindo com o início da estação chuvosa (novembro a janeiro). A cada episódio verificou-se um deslocamento do fenômeno no sentido Norte-Sul. A principal medida profilática utilizada foi a divulgação, junto à população, das medidas de redução de exposição ao agente. Para prédios com elevada infestação por mariposas, foi estudada a efetividade da aplicação de inseticida residual, como medida de redução dos níveis de infestação por mariposas. Obteve-se resultados satisfatórios com deltametrina na dose de 50 mg/m² de parede.Epidemic outbreaks of dermatitis caused by Hylesia sp wich occurred in the coastal region of the State of S. Paulo during the period of December 1989 to December 1991 are confirmed. The incident assumed its greatest intensity in Bertioga, in Santos County, where 612 cases were registered. The outbreak also affected 12 other counties in that region and it was estimated that hundred of affected persons sought the Local Health Service Care. The majority presented with erythematous and prutiginous lesions and papula which lasted 7 to 14 days on average. Treatment consisted of systemic administration of antihistamines, and the use of topic corticosteroides and cold compresses. During the abovementioned period, three epidemic episodes, coninciding with the rainy season (November to January), ocurred. They were first observed in the northern part of the coastal area and then spread to the south. Information as to how avoid contact with the moth was the main prophylactic measure. In highly infested buildings the effectiveness of residual insecticide procedure was used in the attempt to reduce the level of moth infestation. Satisfatory results were obtained with deltametrin applied in a dosage of 50 mg/m² of wall

Validation Of The Ebmt Risk Score In Chronic Myeloid Leukemia In Brazil And Allogeneic Transplant Outcome.

The management of chronic myeloid leukemia (CML) has changed radically since the introduction of imatinib therapy. The decision of whether to offer a patient a hematopoietic stem cell transplant (HSCT) must be based on the probability of success of the procedure. The aim of this retrospective analysis of 1,084 CML patients who received an allogeneic HSCT in 10 Brazilian Centers between February 1983 and March 2003 was to validate the EBMT risk score. The study population comprised 647 (60%) males and 437 (40%) females, with a median age of 32 years old (range 1 - 59); 898 (83%) were in chronic phase, 146 (13%) were in accelerated phase and 40 (4%) were in blast crisis; 151 (14%) were younger than 20 years old, 620 (57%) were between 20 and 40 and 313 (29%) were older than 40; 1,025 (94%) received an HLA fully matched sibling transplant and only 59 (6%) received an unrelated transplant. In 283 cases (26%) a male recipient received a graft from a female donor. The interval from diagnosis to transplantation was less than 12 months in 223 (21%) cases and greater in 861 (79%). The overall survival, disease-free survival, transplant-related mortality and relapse incidence were 49%, 50%, 45% and 25%, respectively. Of the 1084 patients, 179 (17%) had a risk score of 0 or 1, 397 (37%) had a score of 2, 345 (32%) had a score of 3, 135 (12%) had a score of 4 and 28 (2%) a score of 5 or 6. The overall survival (OS) rate in patients with risk scores 0-1 and 2 was similar (58% and 55%, respectively) but significantly better than that in patients with scores 3 or more (score 3 - 44%, 4 - 36 % and 5-6 - 27%, respectively) pp<0.001). Disease-free survival (DFS) and transplant related mortality (TRM) in a patients with a score of 3 or more were 46% and 49%, respectively and the relapse rate beyond score 5-6 was 77%. Disease status had a negative impact on all outcomes (OS, DFS, TRM, and relapse). The OS rate for male recipients of a graft from a female donor was 40% compared to 52% among the other donor-recipient pairs (p=0.004). DFS and TRM were significant for disease phase and female donor-male recipient (p<0.001 and p<0.003, respectively). In our experience, age and interval between diagnosis and transplant did influence OS, DFS, TRM, and relapse rate. Our results validate the EBMT risk score in the context of a developing country and confirm its usefulness for making point decisions in the imatinib era.90232-

Effectiveness and safety of first-generation protease inhibitors in real-world patients with hepatitis C virus genotype 1 infection in Brazil: a multicenter study

OBJECTIVE: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-to-treat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%, p 465 years, diagnosis of cirrhosis, and abnormal hemoglobin levels/platelet counts prior to treatment were associated with serious adverse events. CONCLUSION: Although serious adverse events rates were higher in this infected population, sustained viral response rates were similar to those reported for other patient cohorts.Univ Sao Paulo, Fac Med, Dept Molestias Infecciosas & Parasitarias, Sao Paulo, SP, BrazilUniv Fed Rio de Janeiro, Rio De Janeiro, RJ, BrazilCtr Referencia & Treinamento DST Aids, Sao Paulo, SP, BrazilCDH, Rio De Janeiro, RJ, BrazilHosp Fed Servidores Estado Rio de Janeiro HFSE, Setor Gastrohepatol, Rio De Janeiro, RJ, BrazilUniv Sao Paulo, Fac Med, Dept Gastroenterol & Hepatol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Disciplina Gastroenterol, EPM, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Disciplina Infectol, Sao Paulo, SP, BrazilUniv Sao Paulo, FMRP, Dept Clin Med, Div Gastroenterol, Sao Paulo, SP, Brazil| Univ Fed do Maranhao UFMA, HUPD, Ctr Pesquisa Clin, Sao Luis, MA, BrazilUniv Fed Estado Rio de Janeiro UNIRIO, Disciplina Clin Med & Gastroenterol, Rio De Janeiro, RJ, BrazilUniv Fed Rio do Grande Sul UFRGS, Dept Med Interna, Porto Alegre, RS, BrazilUniv Fed Espirito Santo, Ambulatorio HIV AIDS Hepatites Virais, Vitoria, ES, BrazilSMS, Ctr Orientacao & Aconselhamento, Foz Do Iguacu, PR, BrazilUniv Estado Rio de Janeiro UERJ, Serv Gastroenterol, Rio De Janeiro, RJ, BrazilIMT, Lab Virol LIM 52, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Disciplina Gastroenterol, EPM, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Disciplina Infectol, Sao Paulo, SP, BrazilWeb of Scienc

Effectiveness and safety of first-generation protease inhibitors in real-world patients with hepatitis C virus genotype 1 infection in Brazil: a multicenter study

OBJECTIVE: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-to-treat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%,

Os aspectos semiológicos do acidente vascular encefálico: uma abordagem neurológica

O Acidente Vascular Encefálico (AVC) é um evento neurológico súbito, com um foco de isquemia ou hemorragia. Ambos, qualificados pelo déficit neurológico focal abrupto. Ressaltando, que estes déficits podem ocorrer, sendo a ocorrência espontânea, perduração de 15 minutos, autoresolutiva é denominada como Ataque Isquêmico Transitório (AIT), no entanto, toda insuficiência neural que não melhorar pós esse período deve ser manejado como AVC. O artigo objetivou descrever os principais aspectos clínicos do AVC. O AVC é uma emergência para a saúde pública, em razão de ser um potencial em gerar morbimortalidades para os portadores e prejuízos para os sistemas de saúde. O AVC do tipo isquêmico representa a maioria das ocorrências, o quadro clínico do paciente é correspondente ao tecido neural afetado, inicialmente a tomografia computadorizada sem contraste é o primeiro exame, por ser crucial para descartar a etiologia hemorrágica, a condução terapêutica se baseia em medidas neuroprotetoras através da estabilização da glicemia, temperatura e sódio, adequar os níveis pressóricos, mediante o prazo estipulado impor terapia antitrombótica. A manifestação hemorrágica, pode ocorrer por torção de aneurisma sacular originando o sangramento subaracnóideo ou por hipertensão gerando o sangramento intraparenquimatoso. A partir da análise das informações coletadas, elucida-se que o diagnóstico precoce e o período transcorrido até o manejo terapêutico são cruciais para o desfecho clínico do portador, ou seja, é possível a normalização ou ocorrer sequelas neurais e óbito