ACUTE KIDNEY INJURY CAUSED BY Crotalus AND Bothrops SNAKE VENOM: A REVIEW OF EPIDEMIOLOGY, CLINICAL MANIFESTATIONS AND TREATMENT

SUMMARY Ophidic accidents are an important public health problem due to their incidence, morbidity and mortality. An increasing number of cases have been registered in Brazil in the last few years. Several studies point to the importance of knowing the clinical complications and adequate approach in these accidents. However, knowledge about the risk factors is not enough and there are an increasing number of deaths due to these accidents in Brazil. In this context, acute kidney injury (AKI) appears as one of the main causes of death and consequences for these victims, which are mainly young males working in rural areas. Snakes of the Bothrops and Crotalus genera are the main responsible for renal involvement in ophidic accidents in South America. The present study is a literature review of AKI caused by Bothrops and Crotalus snake venom regarding diverse characteristics, emphasizing the most appropriate therapeutic approach for these cases. Recent studies have been carried out searching for complementary therapies for the treatment of ophidic accidents, including the use of lipoic acid, simvastatin and allopurinol. Some plants, such as Apocynaceae, Lamiaceae and Rubiaceae seem to have a beneficial role in the treatment of this type of envenomation. Future studies will certainly find new therapeutic measures for ophidic accidents

The occurrence and dissemination of methicillin and vancomycin-resistant Staphylococcus in samples from patients and health professionals of a university hospital in Recife, State of Pernambuco, Brazil

Introduction Methicillin-resistant Staphylococcus aureus (MRSA) strains have been responsible for many nosocomial outbreaks. Within hospitals, colonized employees often act as reservoirs for the spread of this organism. This study collected clinical samples of 91 patients admitted to the intensive care unit (ICU), hemodialysis/nephrology service and surgical clinic, and biological samples from the nasal cavities of 120 professionals working in those environments, of a University Hospital in Recife, in the State of Pernambuco, Brazil. The main objective of this study was to determine the occurrence and dissemination of methicillin- and vancomycin-resistant Staphylococcus spp. Methods The isolates obtained were tested for susceptibility to oxacillin and vancomycin and detection of the mecA gene. In addition, the isolates were evaluated for the presence of clones by ribotyping-polymerase chain reaction (PCR). Results MRSA occurrence, as detected by the presence of the mecA gene, was more prevalent among nursing technicians; 48.1% (13/27) and 40.7% (11/27) of the isolates were from health professionals of the surgical clinic. In patients, the most frequent occurrence of mecA-positive isolates was among the samples from catheter tips (33.3%; 3/9), obtained mostly from the hemodialysis/nephrology service. Eight vancomycin-resistant strains were found among the MRSA isolates through vancomycin screening. Based on the amplification patterns, 17 ribotypes were identified, with some distributed between patients and professionals. Conclusions Despite the great diversity of clones, which makes it difficult to trace the source of the infection, knowledge of the molecular and phenotypic profiles of Staphylococcus samples can contribute towards guiding therapeutic approaches in the treatment and control of nosocomial infections

Acute respiratory viral infections in children in Rio de Janeiro and Teresópolis, Brazil

The frequency of viral pathogens causing respiratory infections in children in the cities of Rio de Janeiro and Teresópolis was investigated. Nasal swabs from children with acute respiratory illnesses were collected between March 2006 and October 2007. Specimens were tested for viral detection by conventional (RT)-PCR and/or real time PCR. Of the 205 nasal swabs tested, 64 (31.2%) were positive for at least one of the viral pathogens. Single infections were detected in 56 samples, 50 of those were caused by RNA viruses: 33 samples tested positive for rhinovirus, five for influenza A, five for metapneumovirus, four for coronavirus and, three for respiratory syncytial virus. For the DNA viruses, five samples were positive for bocavirus and one for adenovirus. Co-infections with these viruses were detected in eight samples. Our data demonstrate a high frequency of viral respiratory infections, emphasizing the need for a more accurate diagnosis particularly for the emerging respiratory viruses. The fact that the emerging respiratory viruses were present in 9.2% of the tested samples suggests that these viruses could be important respiratory pathogens in the country

Avaliação das características organizacionais e de desempenho de uma unidade de Atenção Básica à Saúde Evaluación de las características organizacionales y de desempeño de una unidad de Atención Básica a la Salud Evaluation of organizational and performance features in a Basic Health Unit

Este estudo objetiva avaliar as características organizacionais e de desempenho, a partir dos usuários, de uma Unidade Básica de Saúde tradicional, da rede de serviços de Atenção Básica à Saúde. Utilizando os mesmos critérios de uma metodologia de avaliação rápida já validada, e baseando-se no processo amostral de uma pesquisa de livre docência, foi estabelecida a amostra de 55 usuários. O material empírico foi coletado pelo instrumento que compõe o Primary Care Assessment Tool validado para o Brasil. Os resultados revelam o atributo acesso como um dos pontos de estrangulamento do sistema. A prática de atenção não enfoca a família e a comunidade em seu processo de trabalho. A unidade oferece uma diversidade de serviços estabelecendo-se como porta de entrada para o sistema, incorpora ações de coordenação, mas, nem sempre estabelece vínculo com os usuários. Conclui-se a necessidade de investimentos na rede municipal, visando fortalecer os atributos da Atenção Básica.<br>Este estudio tiene como objetivo evaluar las características organizacionales y de desempeño, a partir de la opinión de los usuarios de una Unidad Básica de Salud tradicional, de la red de servicios de Atención Básica a la Salud. La presente investigación estableció muestra de 55 usuarios, utilizando los mismos criterios de una metodología de evaluación rápida ya validada, y teniendo por base el proceso de muestreo de una investigación de libre docencia. El material empírico fue recolectado por el instrumento que compone del Primary Care Assessment Tool, validado para Brasil. Los resultados revelan el acceso como uno de los puntos de estrangulamiento del sistema. La práctica de atención no enfoca la familia ni la comunidad en su proceso de trabajo. La Unidad ofrece una diversidad de servicios y se establece como puerta de entrada para el sistema, incorporando acciones de coordinación, pero ni siempre establece vínculo con los usuarios Se concluye que son necesarias inversiones en la red municipal para fortalecer los atributos de la Atención Básica.<br>This research aimed to evaluate organizational and performance features of a traditional Basic Health Unit, from the Primary Health Care service network, as from users' perspective. The sample of 55 users was established using the same criteria of a rapid evaluation methodology, which was already validated, and based on a free lectureship research sampling process. Empirical data were collected using the Primary Care Assessment Tool instrument, validated for Brazil. Results revealed that access is one of the bottlenecks in the system. Primary Health Care practice does not focus on families and community in its process of work. The Basic Health Unit offers several services, establishing itself as an entrance to the system, however, it not always establishes link with users. Investments are needed in the Brazilian municipal health network in order to strengthen Primary Health Care attributes