No description available.

Objective: Serious morbidity and mortality following snakebite injuries are common in tropical regions of the world. Although antivenom administration is clinically effective, it carries an important risk of early anaphylactic reactions, ranging from relatively benign nausea, vomiting, and urticaria to life-threatening angioedema, bronchospasm and hypotension. Currently, no adequately powered study has demonstrated significant benefit from the use of any prophylactic drug. A high rate of anaphylactic reactions observed during a trial of three different antivenoms in Ecuador prompted adoption of premedication with intravenous (IV) hydrocortisone and diphenhydramine together with dilution and slower administration of antivenom. Design: In a rural mission hospital in Eastern Ecuador, 53 consecutive snakebite victims received a new antivenom regimen in 2004-2006, comprising prophylactic drugs and IV infusion of diluted antivenom over 60 min. They were compared to an historical control cohort of 76 patients treated in 1997-2002 without prophylactic drugs and with IV "push" injection of undiluted antivenom over 10 min. All these patients had incoagulable blood on admission and all were treated with Brazilian Instituto Butantan polyspecific antivenom. Results: Baseline characteristics of the historical control and premedicated groups were broadly similar. In the historical group, early reaction rates were as follows: 51% of patients had no reaction; 35% had mild reactions; 6% moderate; and 6% severe. In the premedicated/slow IV group, 98% of patients had no reaction; 0 mild; 0 moderate; and 2% severe. The difference in reaction rates was statistically significant (p < 0.001). Conclusions: Premedication with intravenous hydrocortisone and diphenhydramine together with dilution of antivenom and its administration by IV infusion over 60 min appeared to reduce both the frequency and severity of anaphylactic reactions. A randomized blinded controlled trial is needed to confirm these encouraging preliminary findings.

Venoms from the most poisonous snakes found in Saudi Arabia were assessed for their physical and chemical characteristics and for their enzymatic and biological activities. Venom from Atractaspis microlepidota was the most lethal in mice followed by the elapids Naja haje arabica and Walterinnesia aegyptia. Among the vipers, Cerastes cerastes venom was the most lethal whereas the remainder (Echis pyramidum, Echis coloratus and Bitfis arietans) showed similar but lower lethality. Antivenoms were raised in sheep by immunising with a low dose of venom (0.5mg) which was then doubled every four weeks. To optimise the antibody response, groups of sheep were immunised with a low, medium and high dose and the monthly bleeds were assessed by ELISA and small-scale affinity chromatography. The immunoglobulin fraction was partially purified by sodium sulphate precipitation and digested with either papain, to form Fab fragments, or with pepsin to produce F(ab)2. The different antivenom fractions produced were characterised and assessed for their ability to neutralise the enzymatic and biological activities of the corresponding venoms. Fab was equally effective as F(ab)2 in most enzymatic and biological assays but the two fractions were less efficient than IgG. The ovine Fab provided good protection in mice against the lethality of these venoms and effectively neutralised their biological and enzymatic activities. The commercial antivenoms currently available in Saudi Arabia showed only partial neutralisation of the enzymatic and biological activities of these venoms and showed in vivo protection only when using large amounts. They offered no protection against W. aegyptia venom. The monospecific ovine Fab raised against E. pyramidum and E. coloratus venoms were more efficient than the polyspecific Fab raised against a mixture of the two venoms.

Submitted by admin tede (tede@pucgoias.edu.br) on 2016-11-22T18:28:57Z No. of bitstreams: 1 LAYANE MARQUES DE SOUZA.pdf: 3595271 bytes, checksum: 8d01d5b4eb1f6e1875b61c882f6ac903 (MD5) / Made available in DSpace on 2016-11-22T18:28:57Z (GMT). No. of bitstreams: 1 LAYANE MARQUES DE SOUZA.pdf: 3595271 bytes, checksum: 8d01d5b4eb1f6e1875b61c882f6ac903 (MD5) Previous issue date: 2016-03-28 / This study had descriptive and retrospective character in order to get an overview of cases of scorpionism in the State of Goiás between 2003 and 2012, describing the possible variables that influenced the accidents. Data were obtained from the collection directly from the Toxicological Information Center notification forms of Goiás (CIT). It was analyzed a total of 6,046 cases of accidents with scorpions for the state in this time frame. In the monthly distribution of the cases found little variation in the number of accidents. Where we obtained 71.65% of cases occurring in urban areas and between genders were almost evenly distributed with most of the involvements with male with 51.88%. The scorpion sting area prevailed in hands, feet and fingers, which together add up to 72.83%. The time between the accident and medical care in the State of Goiás prevailed mostly less than 3 hours. The highest number of reported accidents was related to patients aged between 20 to 40 years old. It was found that the age groups between 0 to 10 years and above 50 years there has been a higher rate of deaths related to other age groups. In all cases, according to the clinical picture 72.42% were classified as mild. Regarding the evolution of accidents, 81.17% of the cases had healing as prognosis. As for treatment with antivenom, 37% made use of serum antiscorpion equating to 38% who did not use the serum antiscorpion as a treatment and 25% was not informed about the mode of treatment. For treatment with antivenom, it was used 2,237 ampoules including serum antiscorpion, antiarachnid and antibothropic. In cases classified as mild used at least 1 ampoule to a maximum of 10 ampoules. In moderate cases at least 1 ampoule to a maximum of 15 ampoules or in severe cases at least 1 ampoule to a maximum of 20 ampoules. By correlating the data provided by SINAN and the data collected in CIT reporting forms, there was a discrepancy in number of cases every year in both Information Systems. Regarding the rainfall, the average accident presents a discrete relation to the rainy season. We have not found a direct relation between the months with higher temperatures and the increasing number of records of the accident. The antivenom treatment revealed serious problems arising from lack of classification of cases, and consequently an exaggerated use of SAE ampoules. As it can be emphasized by the overuse of serum vials, considering that most cases were mild injury. The assimilation of cases in both genders and in the areas of largest urban agglomeration is highly suggestive of scorpion's relationship to the process of domestication. The difference in data between SINAN and CIT suggests that there is a miscommunication between both systems. / Este estudo teve caráter descritivo e retrospectivo com o objetivo de obter um panorama dos casos de escorpionismo no Estado de Goiás entre 2003 e 2012, apresentando as possíveis variáveis que influenciaram nos acidentes. Os dados foram obtidos a partir da coleta de dados das fichas de notificação do Centro de Informações Toxicológicas de Goiás (CIT). Foi analisado um total de 6.046 casos de acidentes com escorpiões para o estado neste recorte temporal. Na distribuição mensal dos casos verificou-se pouca variação no número de acidentes. Em 71,65 % dos casos foram ocorridos em áreas urbanas e entre os gêneros foram quase que uniformemente distribuídos com a maioria dos acometimentos com o sexo masculino com 51,88%. A região da picada prevaleceu em mãos, pés e dedos, que juntos somam 72,83%. O tempo entre o acidente e a assistência médica no Estado de Goiás prevaleceu em sua maioria inferior a três horas. De todos os casos, de acordo com o quadro clínico, 72,42% foram classificados como leves. Com relação à evolução dos acidentes, 81,17% dos casos tiveram a cura como prognóstico. Quanto ao tratamento com soroterapia, 37% fizeram uso do soro equiparando com 38% que não utilizaram o soro como tratamento e em 25% não foi informado o modo de tratamento. Para o tratamento com soroterapia, utilizaram 2.237 ampolas de soro incluindo antiescorpiônico, antiaracnídico e antibotrópico. Em casos classificados como leves foram utilizados no mínimo uma ampola ao máximo de dez ampolas. Nos casos moderados de no mínimo uma ampola ao máximo de 15 ampolas e nos casos graves de no mínimo uma ampola ao máximo de 20 ampolas. Ao correlacionar os dados disponibilizados pelo SINAN e os dados coletados nas fichas de notificação do CIT, houve uma discrepância de quantidade de casos em todos os anos nos dois Sistemas de Informação. Com relação à pluviosidade, a média de acidentes apresenta uma discreta relação com os meses chuvosos. Não houve uma relação direta entre os meses com temperaturas mais elevadas e o aumento do número de registros do acidente. A soroterapia revelou sérios problemas decorrentes da falta de classificação dos casos, e em consequência um uso excessivo de ampolas do SAE. Como pode ser enfatizado pelo uso exagerado de ampolas de soro, haja vista, que a maioria dos casos foi de agravo leve. A equiparação de casos nos dois gêneros e nas áreas de maior aglomerado urbano é altamente sugestiva da relação do escorpionismo com o processo de domiciliação. A diferença de dados entre SINAN e CIT sugere que existe uma falha na comunicação entre os dois sistemas.

A síndrome hemorrágica causada por contato com lagartas da Lonomia obliqua tem alcançado proporções epidêmicas no sul do Brasil. O objetivo deste estudo foi avaliar a eficácia de diferentes doses do soro antilonômico (SALon) no tratamento de pacientes que tiveram contato com lagartas da Lonomia obliqua. Um ensaio clínico prospectivo, randomizado, duplo-cego foi realizado no hospital universitário São Vicente de Paulo de Passo Fundo, RS, Brasil. Entre janeiro de 2000 a março de 2002, 44 pacientes portadores de síndrome hemorrágica grau I e grau II foram randomizados em dois grupos: Grupo A: 22 pacientes que receberam uma dose de 10,5mg (três ampolas) de SALon; Grupo B: 22 pacientes que receberam uma dose de 17,5mg (cinco ampolas) de SALon. A eficácia do tratamento foi avaliada pelo tempo necessário para normalização dos fatores de coagulação sangüínea, freqüência de reações adversas e dias de hospitalização. Não houve diferença no quadro clínico e nas alterações laboratoriais entre os dois grupos. O tempo médio para normalizar o tempo de coagulação foi de 15,3 ± 6,6 h e de 19,1 ± 8 h nos grupos A e B, respectivamente (P = 0,09). A freqüência de reações adversas e o tempo de internação hospitalar foram semelhantes entre os dois grupos. O uso do soro antilonômico foi efetivo e bem tolerado. Doses substancialmente menores das preconizadas podem ser suficientes para reverter à síndrome hemorrágica causada pelo envenenamento por contato com lagartas da Lonomia obliqua. / The hemorrhagic syndrome caused by contact with Lonomia obliqua caterpillars has reached epidemic proportions in southern Brazil. This study aimed at assessing the efficacy of different dosages of an antilonomic serum (SALon) in the treatment of patients who had accidental contact with Lonomia obliqua caterpillars. A randomized, double-blinded, prospective clinical trial was conducted at São Vicente de Paulo Hospital, a tertiary hospital in Passo Fundo, Brazil. From January 2000 to April 2002, 44 patients with grade I or II hemorrhagic syndrome were randomly assigned to either group A (22 patients treated with 10,5mg total dose, 3 vials of SALon) or group B (22 patients treated with 17,5mg total dose, 5 vials of SALon). Treatment efficacy was assessed according to time necessary for blood coagulation to go back to normal, incidence of adverse reactions, and hospitalization time. There were no differences in clinical picture and laboratory findings between the two groups. Mean time for coagulation to go back to normal was 15.3±6.6 h and 19.1±8 h in groups A and B, respectively. Adverse reactions and hospitalization time were similar in both groups. SALon was effective and well tolerated. Results suggest that substantially smaller doses than those routinely prescribed may be sufficient for the treatment of envenoming by Lonomia caterpillars.

A síndrome hemorrágica causada por contato com lagartas da Lonomia obliqua tem alcançado proporções epidêmicas no sul do Brasil. O objetivo deste estudo foi avaliar a eficácia de diferentes doses do soro antilonômico (SALon) no tratamento de pacientes que tiveram contato com lagartas da Lonomia obliqua. Um ensaio clínico prospectivo, randomizado, duplo-cego foi realizado no hospital universitário São Vicente de Paulo de Passo Fundo, RS, Brasil. Entre janeiro de 2000 a março de 2002, 44 pacientes portadores de síndrome hemorrágica grau I e grau II foram randomizados em dois grupos: Grupo A: 22 pacientes que receberam uma dose de 10,5mg (três ampolas) de SALon; Grupo B: 22 pacientes que receberam uma dose de 17,5mg (cinco ampolas) de SALon. A eficácia do tratamento foi avaliada pelo tempo necessário para normalização dos fatores de coagulação sangüínea, freqüência de reações adversas e dias de hospitalização. Não houve diferença no quadro clínico e nas alterações laboratoriais entre os dois grupos. O tempo médio para normalizar o tempo de coagulação foi de 15,3 ± 6,6 h e de 19,1 ± 8 h nos grupos A e B, respectivamente (P = 0,09). A freqüência de reações adversas e o tempo de internação hospitalar foram semelhantes entre os dois grupos. O uso do soro antilonômico foi efetivo e bem tolerado. Doses substancialmente menores das preconizadas podem ser suficientes para reverter à síndrome hemorrágica causada pelo envenenamento por contato com lagartas da Lonomia obliqua. / The hemorrhagic syndrome caused by contact with Lonomia obliqua caterpillars has reached epidemic proportions in southern Brazil. This study aimed at assessing the efficacy of different dosages of an antilonomic serum (SALon) in the treatment of patients who had accidental contact with Lonomia obliqua caterpillars. A randomized, double-blinded, prospective clinical trial was conducted at São Vicente de Paulo Hospital, a tertiary hospital in Passo Fundo, Brazil. From January 2000 to April 2002, 44 patients with grade I or II hemorrhagic syndrome were randomly assigned to either group A (22 patients treated with 10,5mg total dose, 3 vials of SALon) or group B (22 patients treated with 17,5mg total dose, 5 vials of SALon). Treatment efficacy was assessed according to time necessary for blood coagulation to go back to normal, incidence of adverse reactions, and hospitalization time. There were no differences in clinical picture and laboratory findings between the two groups. Mean time for coagulation to go back to normal was 15.3±6.6 h and 19.1±8 h in groups A and B, respectively. Adverse reactions and hospitalization time were similar in both groups. SALon was effective and well tolerated. Results suggest that substantially smaller doses than those routinely prescribed may be sufficient for the treatment of envenoming by Lonomia caterpillars.

A síndrome hemorrágica causada por contato com lagartas da Lonomia obliqua tem alcançado proporções epidêmicas no sul do Brasil. O objetivo deste estudo foi avaliar a eficácia de diferentes doses do soro antilonômico (SALon) no tratamento de pacientes que tiveram contato com lagartas da Lonomia obliqua. Um ensaio clínico prospectivo, randomizado, duplo-cego foi realizado no hospital universitário São Vicente de Paulo de Passo Fundo, RS, Brasil. Entre janeiro de 2000 a março de 2002, 44 pacientes portadores de síndrome hemorrágica grau I e grau II foram randomizados em dois grupos: Grupo A: 22 pacientes que receberam uma dose de 10,5mg (três ampolas) de SALon; Grupo B: 22 pacientes que receberam uma dose de 17,5mg (cinco ampolas) de SALon. A eficácia do tratamento foi avaliada pelo tempo necessário para normalização dos fatores de coagulação sangüínea, freqüência de reações adversas e dias de hospitalização. Não houve diferença no quadro clínico e nas alterações laboratoriais entre os dois grupos. O tempo médio para normalizar o tempo de coagulação foi de 15,3 ± 6,6 h e de 19,1 ± 8 h nos grupos A e B, respectivamente (P = 0,09). A freqüência de reações adversas e o tempo de internação hospitalar foram semelhantes entre os dois grupos. O uso do soro antilonômico foi efetivo e bem tolerado. Doses substancialmente menores das preconizadas podem ser suficientes para reverter à síndrome hemorrágica causada pelo envenenamento por contato com lagartas da Lonomia obliqua. / The hemorrhagic syndrome caused by contact with Lonomia obliqua caterpillars has reached epidemic proportions in southern Brazil. This study aimed at assessing the efficacy of different dosages of an antilonomic serum (SALon) in the treatment of patients who had accidental contact with Lonomia obliqua caterpillars. A randomized, double-blinded, prospective clinical trial was conducted at São Vicente de Paulo Hospital, a tertiary hospital in Passo Fundo, Brazil. From January 2000 to April 2002, 44 patients with grade I or II hemorrhagic syndrome were randomly assigned to either group A (22 patients treated with 10,5mg total dose, 3 vials of SALon) or group B (22 patients treated with 17,5mg total dose, 5 vials of SALon). Treatment efficacy was assessed according to time necessary for blood coagulation to go back to normal, incidence of adverse reactions, and hospitalization time. There were no differences in clinical picture and laboratory findings between the two groups. Mean time for coagulation to go back to normal was 15.3±6.6 h and 19.1±8 h in groups A and B, respectively. Adverse reactions and hospitalization time were similar in both groups. SALon was effective and well tolerated. Results suggest that substantially smaller doses than those routinely prescribed may be sufficient for the treatment of envenoming by Lonomia caterpillars.

Ce travail avait pour objectif de mieux évaluer les critères intrinsèques d’un antivenin et de son utilisation afin d’être le plus efficace possible dans le traitement des envenimations ophidiennes survenant sur le territoire de France métropolitaine. L’immunothérapie est à ce jour le seul traitement étiologique efficace dans la prise en charge des victimes d’envenimation ophidienne. La qualité des antivenins est un élément clé dans l’efficacité et la tolérance de ces traitements. Pour une efficacité optimale, l’immunothérapie doit être administrée le plus rapidement possible. Il ressort enfin que les caractéristiques des envenimations sont en évolution constante sur le territoire métropolitain : émergence de signes neurotoxiques dans les envenimations vipérines ; développement de l’importation de serpents exotiques. Tous ces éléments incitent à une surveillance spécifique par des structures expertes et spécialisées dans le domaine. / This work aimed to assess antivenom criteria in order to be most effective in the treatment of snake bites occurring in metropolitan France. Immunotherapy is the only effective etiological treatment in snake envenomation, considered as a gold standard. Quality of antivenoms is a key element for effectiveness and safety. Immunotherapy should be administered as soon as possible. Finally, it appears that the characteristics of envenomation are constantly changing on the mainland : emergence of neurotoxic signs in viper envenomation; importation of exotic snakes. All these emerging elements need a specific monitoring by expert and specialized structures in France.

Made available in DSpace on 2016-07-18T17:53:16Z (GMT). No. of bitstreams: 1 HERNANI.pdf: 682841 bytes, checksum: 123b8897c9af4f77d7e652384fa3483c (MD5) Previous issue date: 2014-03-24 / Introduction: Snakebites in some countries are among the 10 leading causes of death and heterologous antivenom is the only effective treatment for over 100 years. However, problems in its production and control until now have not been fully resolved and early and late adverse reactions are common serotherapy. In most case reports, clinical and laboratory findings are related to the subject that had been chopped and received antivenom, so there is the question whether the changes are related only to the action of the venom and also the action of the serum. Studies report evidence that excessive amounts of antivenom are in use, resulting in a high incidence of reactions. Therefore, this study aimed to evaluate the effect of different antivenoms on liver function in Wistar rats. One hundred and fifty animals were distributed in five groups as follows: group 1 (G1) - received anticrotalic serum for human use; group 2 (G2) - antivenom for human use; group 3 (G3) - serum antibothropic-crotalic for human use; group 4 (G4) - serum antibothropic-crotalic for veterinary use; group 5 (G5 control) - received saline. Serum dosage of alanine aminotransferase, aspartate aminotransferase, gammaglutamyltransferase, alkaline phosphatase and liver histopathology with 2, 8 and 24 hours was performed. The statistical analyzes were performed using analysis of variance with contrasts using the Tukey method, ANOVA and Kruskal-Wallis. The level of significance was 5%. Results: In the groups treated with antivenom, we observed increased alanine aminotransferase and alkaline phosphatase, no change in aspartate aminotransferase and gammaglutamyltransferase, and congestion, decreased glycogen, vacuolar degeneration, Kupffer cell hyperplasia and centrilobular necrosis in the histopathological analysis. Conclusions: The antivenom used in this assay when administered intraperitoneally, caused hepatic changes in Wistar rats, suggesting new studies related to adequacy in conduct as the dose of serum to be used in snakebite, need to produce higher quality sera and greater safety for patients. / Os acidentes ofídicos em alguns países estão entre as 10 principais causas de morte em seres humanos e a soroterapia heteróloga é o único tratamento eficaz há mais de 100 anos. No entanto, problemas na sua produção e controle até hoje não foram totalmente resolvidos e reações adversas precoces e tardias à soroterapia são comuns. Na maioria dos relatos de caso, os achados clínicos e laboratoriais estão relacionados ao sujeito que já havia sido picado e recebido a soroterapia, assim fica a dúvida se as alterações só estão relacionadas à ação do veneno ou também a ação do soro. Estudos relatam evidências que quantidades excessivas de antiveneno estão sendo utilizadas, resultando em uma elevada incidência de reações. Desta forma, este estudo teve como objetivo avaliar a ação de diferentes antivenenos sobre a função hepática em ratos Wistar. Cento e cinqüenta animais foram distribuídos em cinco grupos como se segue: grupo 1 que receberam soro anticrotálico para uso humano; grupo 2 que receberam soro antibotrópico para uso humano; grupo 3 que receberam soro antibotrópico-crotálico para uso humano; grupo 4 que receberam soro antibotrópico-crotálico para uso veterinário; grupo 5 que receberam solução fisiológica. Foi realizado dosagem sérica de alaninoaminotransferase, aspartato aminotransferase, gama glutamiltransferase , fosfatase alcalina e histopatologia do fígado com 2, 8 e 24 horas. Os testes estatisticos utilizados foram de análise de variância com contrastes pelo método de Tukey, Anova e Kruskal-Wallis. O nível de significância adotado foi de 5%. Nos grupos tratados com antiveneno, observou-se aumentou de alanino aminotransferase e da fosfatase alcalina, ausência de alteração de aspartato aminotransferase e gama glutamiltransferase , além de congestão, diminuição de glicogênio, degeneração vacuolar, hiperplasia das células de Kupffer e necrose centrolobular na análise hitopatológica. Os antivenenos utilizados neste ensaio, quando administrados por via intraperitoneal, na dose de 2 mL, causaram alterações hepáticas em ratos Wistar, sugerindo assim novos estudos relacionados a adequação da conduta quanto a dose de soro a ser usada no acidente ofídico, necessidade de produção de soros de maior qualidade e de maior segurança aos pacientes.

O envenenamento ofídico é considerado uma condição tropical negligenciada pela OMS, e no Brasil, o gênero Bothrops está envolvido na maioria dos casos. Primeiramente, estudamos a atividade hidrolítica do veneno de B. jararaca sobre peptídeos biologicamente ativos que podem estar relacionadas com o envenenamento. A hidrólise dos peptídeos que foram substratos para as serinopeptidases não foi eficientemente bloqueada pelo soro antibotrópico produzido pelo Instituto Butantan e, portanto, as causas dessas falhas foram investigadas. Para isso, purificamos quatro serinopeptidases não bloqueadas pelo soro e, por estudos imunoquímicos, observamos que apesar deste não bloquear as atividades destas enzimas, o mesmo é capaz de reconhecê-las. Portanto, decidimos obter soros experimentais contra estas moléculas utilizando camundongos, a fim de compará-los com o soro comercial. Os soros experimentais contra as serinopeptidases mostraram capacidade de reconhecimento e alta afinidade contra elas, e mais importante, capacidade de neutralizar suas atividades in vitro. / Snakebite is considered a neglected tropical condition by WHO, and in Brazil, the Bothrops genus is involved in most of the cases. Initially, we have studied the B. jararaca venom activity over bioactive peptides which could be related with the envenomation. The hydrolysis of the peptides substrate for serinepeptidases were not efficiently blocked by the Butantan Institute bothropic antivenom, therefore, the causes of this flaw were investigated. Thereafter, we purified four serinepeptidases not blocked by the antivenom and, by immunochemistry analysis, we observed that although it could not neutralize the activity, it could well recognize these proteins. Thus, we decided to obtain experimental sera against these serinepeptidases in mice, in order to compare it with the commercial antivenom. The experimental sera against these enzymes demonstrated recognition capability and high affinity, and most important, the ability to neutralize their activity in vitro.