RESUMO: Acidentes por picada de abelhas são frequentemente descritos em humanos e cães, entretanto relatos em cavalos são escassos. Este trabalho teve como objetivo descrever um caso de insuficiência renal aguda em um equino após múltiplas picadas de abelhas. Uma égua foi atacada por um enxame de abelhas desenvolvendo quadro clínico de relutância em se movimentar, epistaxe e urina marrom-escura. Exames bioquímicos demonstraram aumento nos níveis séricos de ureia e creatina. O equino não respondeu ao tratamento e a eutanásia foi realizada após quatro dias de curso clínico. Na necropsia havia múltiplas elevações cutâneas, que ao corte exibiam edema e hemorragia, os quais se estendiam ao subcutâneo e musculatura adjacente. Os rins estavam difusamente marrom-escuros e havia friáveis. Microscopicamente, os túbulos renais estavam distendidos e preenchidos por um material hialino, globular, laranja-avermelhado e havia acentuada necrose das células epiteliais tubulares. O diagnóstico foi obtido por meio da análise clínica e histológica, e a avaliação patológica foi essencial para confirmar a insuficiência renal aguda por picada de abelha.

ABSTRACT: Bee envenomation is frequent in humans and dogs, but uncommon in horses. This study aimed to describe a case of acute renal failure following mass envenomation in a horse. A mare was attacked by a swarm of bees and showed reluctance to move, epistaxis, and dark-brown urine. Biochemical exams revealed increase in urea and creatine serum levels. The mare did not respond to treatment and euthanasia was elected after four days of clinical course. At the necropsy, there were multifocal pinpoint to elevated skin lesions associated with edema and hemorrhage, which extended to the subcutaneous tissue and skeletal muscle, and the kidneys were diffusely dark-brown and friable. Microscopically, renal tubules were distended and filled with an orange-red, hyaline globular material, and had severe epithelial tubular cell necrosis. The diagnosis was established based on clinical and histological analysis, and pathological evaluation was essential to confirm acute renal failure due to bee sting toxicity.

Objectives: (1) To document trends in integrated management of childhood illnesses (IMCI) implementation in the 24 departments of Peru from 1996 to 2000. (2) To document trends in indicators of health services coverage and impact (mortality and nutritional status) for the same period. (3) To correlate changes in these two sets of indicators. And (4) to attempt to rule out contextual factors that may affect the observed trends and correlations. Materials and Methods: An ecological analysis was performed in which the units of study were the 24 departments. Results: By 2000, 10,2% of clinical health workers were trained in IMCI, but some districts showed considerably higher rates. There were no significant associations between clinical IMCI training coverage and indicators of outpatient utilization, vaccine coverage, mortality or malnutrition. The lack of association persisted after adjustment for several contextual factors including socioeconomic and environmental indicators and the presence of other child health projects. Community health workers were also trained in IMCI, and training coverage was not associated with any of the process or impact indicators, except for a significant positive correlation with mean height for age. According to the MCE impact model, IMCI implementation must be sufficiently strong to lead to an impact on health and nutrition. Conclusions: Health systems support for IMCI implementation in Peru was far from adequate. This finding along with low training coverage level and a relatively low child mortality rate may explain why the expected impact was not documented. Nevertheless, even districts with high levels of training coverage failed to show an impact. Further national effectiveness studies of IMCI and other child interventions are warranted as these interventions are scaled up.

Objetivos: 1) Documentar las tendencias en la implementación de la atención integrada a las enfermedades prevalentes de la infancia (Aiepi) en los 24 departamentos del país, de 1996 al 2000. 2) Documentar las tendencias en los indicadores de cobertura de servicios de salud y en los de impacto (mortalidad y estado nutricional) para el mismo período. 3) Correlacionar los cambios en estos dos grupos de indicadores. Y, 4) intentar descartar factores contextuales que puedan afectar las tendencias y las correlaciones observadas. Materiales y Métodos: Se realizó un análisis ecológico en el que las unidades de estudio fueron los 24 departamentos. Resultados: Para el 2000, 10,2% de trabajadores clínicos (médicos y enfermeras) fueron capacitados en Aiepi, pero solo algunos departamentos mostraron tasas considerablemente mayores. No hubo asociaciones significativas entre la cobertura de capacitación clínica en Aiepi y los indicadores de utilización de consultas externas, cobertura de vacunas, mortalidad o desnutrición. La falta de asociación persistió luego de haber realizado el ajuste de varios factores contextuales incluyendo indicadores socioeconómicos y ambientales y la presencia de otros proyectos de salud del niño. Los agentes comunitarios de salud también fueron capacitados en Aiepi y la cobertura de capacitación no estuvo asociada con ninguno de los indicadores de proceso o de impacto, excepto una correlación positiva y significativa con el promedio de talla para edad. De acuerdo al modelo de impacto de la Evaluación Multi-País del Impacto, Costo y Efectividad de Aiepi (EMP), la implementación de Aiepi debe ser lo suficientemente fuerte para llevar a un impacto en la salud y la nutrición. Conclusiones: El soporte de los sistemas de salud para la implementación de Aiepi en el Perú estuvo lejos de ser adecuada, y esto, así como coberturas de capacitación relativamente bajas, pueden explicar porqué no se documentó el impacto esperado. Sin embargo, incluso los departamentos con altos niveles de cobertura de capacitación no mostraron un impacto. Se discute estos resultados en el contexto de otros dos estudios de la EMP, realizados en Tanzania y Bangladesh, en los que se constató un impacto positivo de Aiepi fuertemente implementado, y se propone posibles explicaciones para estas discrepancias.