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Snakebite is a common neglected public health issue, especially in poor rural areas of sub-Saharan Africa, Asia and Latin America. Passive immunotherapy with safe and effective antivenom is the only approved treatment for it. This study aimed to determine the incidence of snakebites, and to assess the availability and accessibility of antivenoms, from 2010 to 2014, in Burkina Faso. Methods The assessment of snakebite cases managed in all health facilities from 2010 to 2014 was performed from the Statistical Yearbook of the Ministry of Health. Antivenom consumption data were collected from the drug wholesalers established in Burkina Faso. Results Snakebites are among the five leading causes of consultations in health districts. From 2010 to 2014, 114,126 envenomation cases occurred in Burkina Faso, out of which 62,293 (54.6 %) victims have been hospitalized resulting in 1,362 (2 %) deaths. The annual incidence and mortality were respectively 130 bites and 1.75 deaths per 100,000 inhabitants. The amount of antivenom sold by wholesalers were 5,738 vials with a total cost of US$ 539,055 (annual average = US$ 107,811). The high cost of these antivenoms (between US$ 42 and 170 per dose according to brand) limited their use by rural people, the main victims of snakebites, whose income is insufficient. Thus, only 4 % of patients received antivenom treatment over the past five years. The price of antivenom was reduced in 2015 to US$ 3.4 by a public drug wholesaler. Conclusion The study confirmed the high burden of snakebites in Burkina Faso. To better manage envenomation, Burkina Faso implemented a strategy consisting in seeking affordable sources of antivenom supply of good quality and innovative mechanisms of subsidy.

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Snakebite is a common neglected public health issue, especially in poor rural areas of sub-Saharan Africa, Asia and Latin America. Passive immunotherapy with safe and effective antivenom is the only approved treatment for it. This study aimed to determine the incidence of snakebites, and to assess the availability and accessibility of antivenoms, from 2010 to 2014, in Burkina Faso. Methods The assessment of snakebite cases managed in all health facilities from 2010 to 2014 was performed from the Statistical Yearbook of the Ministry of Health. Antivenom consumption data were collected from the drug wholesalers established in Burkina Faso. Results Snakebites are among the five leading causes of consultations in health districts. From 2010 to 2014, 114,126 envenomation cases occurred in Burkina Faso, out of which 62,293 (54.6 %) victims have been hospitalized resulting in 1,362 (2 %) deaths. The annual incidence and mortality were respectively 130 bites and 1.75 deaths per 100,000 inhabitants. The amount of antivenom sold by wholesalers were 5,738 vials with a total cost of US$ 539,055 (annual average = US$ 107,811). The high cost of these antivenoms (between US$ 42 and 170 per dose according to brand) limited their use by rural people, the main victims of snakebites, whose income is insufficient. Thus, only 4 % of patients received antivenom treatment over the past five years. The price of antivenom was reduced in 2015 to US$ 3.4 by a public drug wholesaler. Conclusion The study confirmed the high burden of snakebites in Burkina Faso. To better manage envenomation, Burkina Faso implemented a strategy consisting in seeking affordable sources of antivenom supply of good quality and innovative mechanisms of subsidy.(AU)

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Intoxications have become a relevant complaint in the emergency room since the second half of the last century. Toxidromes have been replaced by a more practical combined analysis of vital signs, directed physical examination and selected laboratory tests. Most of the mortality can be prevented by the correct and opportune implementation of general management strategies, including supportive care, prevention of absortion, enhancement of elimination and extracorporeal removal of toxins. Through the following pages we will review many of different diagnostic and therapeutic alternatives...

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A cross-sectional study of secondary data/information obtained from the Hospital Information System (HIS) spanning the years 2008 - 2009 was performed. The distribution of the main hospital admissions by gender, age, color/race, region and federal unit of residence, average expenditure and average length of hospital stay, year of hospitalization and mortality rates (MR) were studied. The data collected were tabulated by TabNet and keyed into Microsoft Excel 2007. It was verified that elderly males (54.3%), from 60 to 69 years old (50.6%), nonwhites (36.3%) and residents of Southeast and North regions of the country had the highest rates of hospitalization. Seniors were hospitalized for an average of 4.8 days, and the major causes were exposure to alcohol (43.7%) and to drugs (33.9%). Expenses related to hospital admissions were, on average, R$ 529,817.70. The highest mortality rates were recorded among females (MR = 4.34), in elderly, 80 years or older (MR = 10.16) and Caucasians (MR = 3.95), where pharmacological substances with action on the Autonomic Nervous System were the leading cause of death. There are demographic differences in morbi-mortality of these elderly since, although men and younger elderly were the main victims, women and elderly of advanced age have greater mortality. The leading causes of hospitalization were alcohol and drugs.

Realizou-se um estudo transversal de dados secundários obtidos no Sistema de Informação Hospitalar (SIH), nos anos 2008/2009. Estudou-se a distribuição das principais internações segundo sexo; faixa etária; cor/raça; região e unidade federativa de residência; valor médio pago e média de permanência das internações hospitalares; ano de internação e as taxas de mortalidade (TM). Os dados coletados foram tabulados por meio do TabNet e transcritos para o Programa Microsoft Excel® 2007. Verificou-se que idosos do sexo masculino (54,3%), com 60 e 69 anos de idade (50,6%), não brancos (36,3%) e residentes nas regiões Sudeste e Norte do País apresentaram os maiores percentuais de internação hospitalar. Idosos ficam em média 4,8 dias internados, sendo as principais causas a exposição ao álcool (43,7%) e a medicamentos (33,9%). Os gastos com as internações equivaleram a R$ 529.817,70. As maiores taxas de mortalidade foram registradas no sexo feminino (TM=4,34), em idosos entre 80 anos e superior (TM=10,16) e pessoas brancas (TM=3,95), sendo as substâncias farmacológicas de ação sobre o Sistema Nervoso Autônomo maiores causas do óbito. Existem diferenças demográficas na morbimortalidade desses idosos, visto que apesar de homens e idosos mais jovens serem as principais vítimas, mulheres e idosos com idade mais avançada morrem mais. Sendo as principais causas de internação o álcool e os medicamentos.

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Envenoming by the contact of human skin with Lonomia obliqua caterpillars promotes a hemorrhagic syndrome characterized by a consumptive coagulopathy. Losac (Lonomia obliqua Stuart factor activator) is a component of the bristle of L. obliqua that is probably partially responsible for the observed syndrome because it activates factor X and is recognized by an effective antilonomic serum. Here we unveil the proteolytic activity of Losac and demonstrate the feasibility of its recombinant production. On the other hand, Losac has no homology to known proteases, but it can be inhibited by PMSF, a serine protease inhibitor. Instead, it shows closer homology to members of the hemolin family of proteins, a group of cell adhesion molecules. The recombinant protein (rLosac) shortened the coagulation time of normal and deficient plasmas, whereas it was ineffective in factor X-deficient plasma unless reconstituted with this protein. rLosac was able to activate factor X in a dose- and time-dependent manner but not ã-carboxyglutamic acid domainless factor X. Moreover, phospholipids and calcium ions increased rLosac activity. Also, rLosac had no effect on fibrin or fibrinogen, indicating its specificity for blood coagulation activation. Linear double reciprocal plots indicate that rLosac follows a Michaelis-Menten kinetics. Cleavage of factor X by rLosac resulted in fragments that are compatible with those generated by RVV-X (a well known factor X activator). Together, our results validate Losac as the first protein from the hemolin family exhibiting procoagulant activity through selective proteolysis on coagulation factor X.

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OBJECTIVE: To describe the profile of poisoning cases among children attended during three years at emergency hospitals in the metropolitan area of Rio de Janeiro, Brazil. METHODS: All confirmed or suspected poisoning cases, due to drugs and biological substances; organic solvents and hydrocarbons; chemical products; carbon monoxide and other gases; and pesticides, were collected. RESULTS: 1,574 cases of poisoning in children up to 5 years of age were detected. Around 40% of the cases involved chemical products of domestic use, 35% were caused by drugs, and 15% by pesticides. More than half of pesticide poisonings involved the 'chumbinho', an illegal product sold as a rodenticide, and usually including in its formulation a carbamate. Distribution of agents varied significantly by gender, the relative frequency of poisonings due to drugs and 'chumbinho' being higher among females than males. Participation of chemical products of domestic use decreased with age, but the role of drugs increased as agents of poisoning. During the observation period there was no significant reduction in the total number of annual cases. CONCLUSION: Supporting the expansion of the network of Poison Control Centers, developing intervention for the production of safer packaging devices for drugs chemical products, suppressing the illegal commerce of 'chumbinho', and fostering health education activities might contribute to modify this situation.

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OBJETIVO: Descrever o perfil dos casos de intoxicações exógenas de crianças admitidas em hospitais de emergência da região metropolitana do Rio de Janeiro, durante três anos. MÉTODOS: Realizou-se levantamento dos dados a partir dos boletins de atendimento de emergência, tendo sido identificados os casos suspeitos ou confirmados de intoxicação nas seguintes categorias: drogas, medicamentos e substâncias biológicas; solventes orgânicos e hidrocarbonetos halogenados; produtos químicos; monóxido de carbono e outros gases, fumaças e vapores; e pesticidas. RESULTADOS: Foram registrados 1.574 casos de intoxicação entre crianças até cinco anos de idade, sendo que cerca de 40 por cento dos casos envolveu produtos químicos de uso doméstico, 35 por cento os medicamentos, e 15 por cento algum tipo de pesticida. Mais da metade das intoxicações por pesticidas envolveu o chumbinho, um produto ilegalmente vendido como raticida, que frequentemente contém o agrotóxico carbamato. A distribuição dos agentes envolvidos variou significativamente segundo sexo, sendo a frequência relativa das intoxicações por medicamentos e chumbinho maior no sexo feminino em comparação ao masculino. Observou-se que a participação dos produtos químicos de uso doméstico decresceu com a idade, enquanto aumentou a dos medicamentos como agentes da intoxicação. No período analisado não observou-se redução significativa no número total de casos registrados anualmente. CONCLUSÃO: Fortalecer a rede de Centros de Controle de Intoxicações, intervir na linha de produção de embalagens para medicamentos e produtos químicos, aumentar a fiscalização sobre a comercialização ilegal do chumbinho, e enfatizar atividades de educação em saúde são ações que podem contribuir para mudar este panorama.

OBJECTIVE: To describe the profile of poisoning cases among children attended during three years at emergency hospitals in the metropolitan area of Rio de Janeiro, Brazil. METHODS: All confirmed or suspected poisoning cases, due to drugs and biological substances; organic solvents and hydrocarbons; chemical products; carbon monoxide and other gases; and pesticides, were collected. RESULTS: 1,574 cases of poisoning in children up to 5 years of age were detected. Around 40 percent of the cases involved chemical products of domestic use, 35 percent were caused by drugs, and 15 percent by pesticides. More than half of pesticide poisonings involved the "chumbinho", an illegal product sold as a rodenticide, and usually including in its formulation a carbamate. Distribution of agents varied significantly by gender, the relative frequency of poisonings due to drugs and "chumbinho" being higher among females than males. Participation of chemical products of domestic use decreased with age, but the role of drugs increased as agents of poisoning. During the observation period there was no significant reduction in the total number of annual cases. CONCLUSION: Supporting the expansion of the network of Poison Control Centers, developing intervention for the production of safer packaging devices for drugs chemical products, suppressing the illegal commerce of "chumbinho", and fostering health education activities might contribute to modify this situation.

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OBJECTIVE: To investigate the secular trends in childhood poisonings leading to hospitalization in Finland. STUDY DESIGN: All children and adolescents age 0 to 19 years hospitalized in Finland with the primary diagnosis of poisoning between 1971 and 2005 were identified using the International Classification of Diseases. RESULTS: During the study period, there were 41 862 hospitalizations with 96 427 hospital bed days for poisoning in 38 582 children and adolescents. The incidence of hospitalization declined from 91.3 admissions per 100 000 person-years in boys and 105.2 per person-years in girls in 1971 to 64.8 in boys and 83.5 in girls in 2005. In the 0- to 4-year age group, admissions declined by 51%. Hospitalizations for alcohol poisoning increased 1.7-fold (95% confidence interval = 1.4 to 2.2) in boys and 2.4-fold (95% confidence interval = 1.8 to 3.3) in girls. Alcohol poisoning was the primary diagnosis in 53% of those in the 10- to 14-year age group. CONCLUSIONS: Poisoning remains an important cause of morbidity in Finnish children and adolescents despite the decreased overall incidence of poisonings leading to hospitalization between 1971 and 2005. The increasing trend of hospital admissions for alcohol poisoning, especially in 10- to 14-year-olds, is noteworthy. Effective primary prevention programs and adult supervision should be targeted at reducing alcohol consumption and alcohol-related poisonings in youth.

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Skin contact with Lonomia caterpillar bristles causes a consumptive coagulopathy. From a cDNA library we cloned and expressed a prothrombin activator (rLopap) in active form, and from the bristles extract we characterized a FX activator (Losac). Several clones were sequenced and analyzed by expressed sequence tags. A database of about 1,270 sequences was constructed and deposited in NCBI. Both the native protein from the venom (Lopap) and the recombinant form (r-Lopap) promoted prothrombin hydrolysis, generating prethrombin-2, F1.2 and thrombin. Losac is a single-chain (43 kDa) protein that cleaves the FX heavy chain producing FXaá. In HUVECs rLopap and Losac are able to modulate cell survival by preventing apoptosis. rLopap increases NO and PGI2 concentration and Losac induces t-PA expression. Finally, to identify the venom proteins related to human envenomation, a 2D electrophoresis map is being performed as an attempt to find the majortoxins recognized by the anti-lonomia venom.

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Objetivo: Describir y caracterizar la epidemiología de las consultas por intoxicaciones, reportados al Centro de Información Toxicológica de la Universidad Católica (CITUC). Método: Se realizó un estudio retrospectivo y descriptivo de las llamadas registradas por el centro durante el período del año 2004. Se analizarán los siguientes datos: número total de llamadas, lugar de la llamada, circunstancias de la exposición, tipo y nº de agentes involucrados, vías de exposición, tiempo desde la exposición, sexo y edad de los pacientes, y las indicaciones y tratamientos recomendados. Resultados: Se registraron 22.168 llamadas. El 52,5 por ciento de las consultas provenían del hogar y el 40,2 por ciento de los Servicios de Urgencia. El 71,6 por ciento de las consultas eran exposiciones accidentales y el 19,8 por ciento fueron intencionales. Los medicamentos se presentaron en un 53,6 por ciento de las llamadas, seguidos por los Productos de Aseo (13,7 por ciento), Productos industriales y Químicos (10,2 por ciento), y Pesticidas (7,1 por ciento). El 92,5 por ciento de las exposiciones eran con un agente tóxico. La ingestión fue la vía de exposición que se registró en un 82 por ciento. El 44,6 por ciento del total de las llamadas, se realizaron dentro de la primera hora post-exposición. Las intoxicaciones en niños menores de 6 años correspondieron al 47,9 por ciento de las llamadas. Conclusiones: Los medicamentos constituyen el principal agente de intoxicación. La principal vía de exposición es la ingesta y que el principal grupo de población afectado son los niños menores de 6 años. Estos son indicadores evidentes y claros de la necesidad imperante de desarrollar campañas publicitarias preventivas e informativas, avaladas por el Ministerio de Salud, respecto al correcto almacenaje de los medicamentos y el manejo de las intoxicaciones en el hogar. La introducción del envase resistente a niños y la educación constituyen dos piezas fundamentales en la prevención de las intoxicaciones pediátricas.

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