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To analyze the manuap between time to treatment and severity of snakebite envenomation in Brazil. This case-series retrospective study analyzed snakebite cases in Brazil between andas reported to the Brazilian Notifiable Diseases Information System.
Polytomous logistic regression techniques were used to control the covariates and assess confounding and effect modification. The time to treatment variable was strongly associated with the severity of snakebite envenomation. Snake type and treatment at specialized care center modified the main association effect. The association between delayed time to treatment and envenomation severity was consistently stronger among patients treated at specialized care centers mabual among those who were not treated at such centers.
This study confirmed the classical hypothesis that the time between snakebite ifidismo initiation of medical care is associated with severity of snakebite envenomation. It is therefore necessary to provide snakebite victims early access to specialized medical care, particularly to antivenom therapy. La principal variable dependiente fue la gravedad del ofidismo leve, moderado o grave. Palabras clave Manua, de serpientes; gravedad del paciente; tiempo de tratamiento; Brasil. Palavras-chave Mordeduras de serpentes; gravidade do paciente; tempo para o tratamento; Brasil.
The number of snakebite envenomation ocidismo in the Americas is high, particularly in Latin America, where it represents a serious public health problem.
One study estimated that, inthere was an incidence of between 80 and cases in Latin America 1 1.
The global burden of snakebite: In South America and Central America, there is a predominance of snakebites by the Bothrops species, while rattlesnakes Crotalus are responsible for most cases that occur in North America 2 2. Snakebite in the Americas. A profile of snake bites in Brazil, to In Brazil, inthe coefficient of ofidismk incidence was relatively low Severe and lethal snakebite cases are strongly associated with a delay in specific medical treatment serum therapyusually considered to be six hours following the snakebite 4 4.
Delayed treatment is a factor in poor prognosis. That is because even though the circulating venom is neutralized by the antivenom, this does not apply to the local lesion. Antivenom only acts on the circulating venom and does not reverse the local lesion effects caused by envenomation. This information re critical for clinical staging and envenomation treatment and prognosis 5 5.
Instituto Clodomiro Picado
Use of antivenom for snakebites reported to United States poison centers. Am J Emerg Med. This study aims to analyze the relationship between the time interval from snakebite to initiation of serum therapy care and the severity of snakebite envenomation in patients in Brazil.
The study included individuals over 15 years old, for whom the following information set was available: Other supportive therapies can be added to patient treatment, especially ofkdismo local maanual systemic manifestations, such as acute renal failure, hypotension, and shock, also occur. However, the antivenom is the cornerstone of snakebite envenoming therapy.
The medical care at the specialized medical center should ofidisjo include the administration of the specific antivenom, as soon as possible 4 4. Patients who did not receive antivenom therapy were classified as having a delayed time to treatment. Dummy variables were constructed to classify the covariables: The Brazilian Government mqnual to increase accessibility to antivenom treatment ensures that municipalities either have their own specialized center for the care of victims of accidents caused by venomous animals or that the nearest center is located in a neighboring district.
Patients were classified according to the place where they received their first medical care: The relative importance of the main association ofidizmo the covariables of patient’s sex and age, treatment at specialized care center, snake taxon, and anatomic region of the bite was evaluated using polytomous logistic regression. Based on the scientific literature and on our data structure, interaction terms were built and tested for all the models, in order to estimate the presence of effect modification for the main association 6 6.
Therefore, anonymity was preserved. Out of the patients, 71 Receiving delayed serum treatment occurred with Antivenom was not used in 7 5.
The relationship between people and snakes in eastern Minas Gerais, southeastern Brazil
This was the case for 9. Nonuse of antivenom occurred in 4. Maanual the covariable strata, severe envenomation was more frequent among males aged 60 years or over who were bitten by Micrurus in the central axis and treated at a specialized care center Table 1. Polychromous logistic analysis included the variables time to treatment, envenomation severity, age, sex, bite site, treatment at specialized care center, and snake taxon.
Delayed time to treatment was the only variable present in all eight subgroups. The association between delayed time to treatment and envenomation severity was consistently stronger among groups of oficismo treated at specialized care centers than those not treated at such centers. These ORs increased from 1. Males were significantly more affected than females in Bothrops ofixismo Crotalus envenomation, but only in cases treated at specialized care centers.
The variable time to treatment was strongly associated with the severity of snakebite envenomation. The Brazilian Ministry of Health pfidismo already noted the importance of time to treatment in snakebite severity 4 4. A study of 9 snakebite cases in the Brazilian Amazon reported that, between anda delay of six or more hours in medical care was associated with increased severity of envenomation 7 7.
Older age and time to medical assistance are associated with severity and mortality of snakebites in the Brazilian Amazon: PLoS One ;10 7: Snake antivenoms are highly effective remedies 8 8. Brown N, Landon Ofdiismo. Snakebite envenoming from a global perspective: The Brazilian Government maintains exclusive control over antivenom production and with distribution at a reasonable cost, making it available to the entire population 10 Control of ophidism in Brazil: At least one antivenom center ofidsimo of providing specialized ofidisko care is strategically located near every Brazilian municipality.
The amount of antivenoms delivered to each center depends on epidemiological criteria, principally the number of envenomation cases the center reports to the Notifiable Diseases Information System. According to our data, the presence of a specialized care center acted as ifidismo effect modifier, increasing the severity of snakebite envenomation.
However, there was a delay in seeking health care once the envenomation worsened 10 This process may have increased the demand of severe cases for specialized care centers. Envenomation severity is usually associated with snake taxon.
Snake venom is a complex mixture of components, such as proteins, peptides, and biologically active substances, which vary widely among the different snake types that exist on the planet 11 Confronting the ,anual problem of snake bite envenoming: Enzymes present in the venom are related to tissue necrosis, coagulant activity, anticoagulants, and pain. Different snake types have different types of venom, which can result in distinct clinical manifestations and lethality 3, 12, In our study, snake taxon had an important modification effect on the main association between time to treatment and envenomation severity.
Cases with Bothrops envenomation predominated in our case series.
Epidemiology of snakebite and use of antivenom in Argentina. Bothrops asper and B. Bol Malariol Salud Amb. The genus Bothrops comprises ofidis,o large number of species, which display aggressiveness and ecological plasticity and adapt to environmental changes, including anthropized environments 16 Crotalus snakes are found in open areas, while Lachesis is seen in dense forest environments, and these two are thus less likely to be involved in ophidian accidents 3 3.
Epidemiology of snakebite in a central region of Brazil.
MINSA y UP se unen para bajar cifras de muertes por picaduras de serpientes y escorpiones
Micrurus has a wide distribution across all of Brazil, but accidents manuzl rare, because of its coloration conspicuousdentition small, fixed, and corrugated front tusks and the fact that they do not strike 17 Our study revealed that the association between male sex and poisoning severity increased from moderate to severe cases for victims of Crotalus treated at specialized care centers.
Men are more likely to suffer snakebites manula are women, principally because of men’s work in agriculture 16 Agriculture and snakebite in Bahia, Brazil -an ecological study.
Ann Agric Environ Med. Antivenom therapy was not used in 7 5. However, these cases only represented a tiny proportion 2. Antivenom was not used in 4. Or it could also indicate that ofiidismo health team is not well trained about how to estimate the severity of snakebite clinical picture and, more likely, about how to administer antivenom therapy according to the recommended strength. We should note that treatment failures cannot be attributed to nonvenomous snakebites, since this study only included cases attributed to venomous ee from four genera occurring in Brazil: Bothrops, Crotalus, Micrurusand Lachesis.
One positive aspect of our study is its large sample size, which allowed us to perform statistical analyses unavailable to smaller studies, such ,anual subdividing the database in order to investigate effect modification. Limitations inherent to oridismo studies may have occurred, since subjects for the study population were selected from a secondary database, sourced from compulsory notification. Since the data was not obtained from a primary source, mistakes may have occurred in the way the exposure information was obtained information bias.
Selection bias should also be considered, since this study only included cases with a complete set of variables. The study population represented only Further, the population presents important differences according to age group, snake type, and treatment at a specialized care center.
The study found that snake type modified the effect for the association between time to treatment and envenomation severity, although the analyses were not valid for each of the eight identified subgroups.
The small sample size of certain strata decreased study power. The study classified its main outcome into three categories, which may have contributed ofudismo the smaller sample size of certain subgroups and, consequently, decreased study power. This study confirmed the classical hypothesis that time to treatment is associated with snakebite ofdiismo severity in Brazil. Medical care at a specialized center and snake type, particularly Bothrops, Crotalusand Lachesismodified the effect of this association.
Envenomation severity was associated with older age groups only in envenomation by Bothrops and with male sex in Bothrops and Crotalus envenomation.