ABSTRACT Background: Ophidic accident is a neglected disease that affects tropical countries. Latin America is the second region after Africa, with the most cases worldwide. Local lesions accompany its clinical course up to systemic affectations such as renal, hematological, and neurological lesions. Cardiac complications are rare, especially in patients who do not have cardiovascular risk factors. There are reports of acute myocardial infarction, but there is little information about heart failure due to Bothrops spp. Case report: We present the case of a 25-year-old man without cardiovascular risk factors who was admitted to the intensive care unit and developed heart failure with cardiogenic shock and multi-organ failure secondary to a snake bite. Conclusions: Although the characteristic clinical course of a bothropic ophidian accident and its systemic manifestations are mainly related to coagulation abnormalities, there are cardiovascular complications within its clinical presentation that, although rare, if not detected promptly and not adequately managed, are associated with high morbidity and mortality.

RESUMEN Antecedentes: El accidente ofídico es una enfermedad desatendida que afecta a los países tropicales. América Latina es la segunda región después de África, con mayor número de casos a nivel mundial. Su curso clínico incluye lesiones locales hasta afectaciones sistémicas como lesiones renales, hematológicas y neurológicas. Las complicaciones cardiacas son raras, especialmente en pacientes que no tienen factores de riesgo cardiovascular. Hay reportes de infarto agudo de miocardio, pero existe poca información sobre la insuficiencia cardíaca debida a Bothrops spp. Reporte de caso: Presentamos el caso de un hombre de 25 años sin factores de riesgo cardiovascular que fue admitido en la unidad de cuidados intensivos y desarrolló insuficiencia cardíaca con choque cardiogénico y fallo multiorgánico secundario a una mordedura de serpiente. Conclusiones: Aunque el curso clínico característico de un accidente ofídico bothrópico y sus manifestaciones sistémicas están principalmente relacionadas con anomalías de la coagulación, hay complicaciones cardiovasculares dentro de su presentación clínica que, aunque raras, si no se detectan prontamente y no se manejan adecuadamente, están asociadas con alta morbilidad y mortalidad.

ABSTRACT: Ophidian accidents have been a medical and veterinary challenge. The only treatment available and recommended by the World Health Organization and the Ministry of Health is serotherapy. This study evaluated the liver function of equines submitted to the immunization protocol currently used by the “Instituto Vital Brazil” to produce anti-Bothrops serum. Five equines were evaluated with Bothrops venom inoculation during three immunization cycles. Blood samples were taken for a biochemical test and a liver assessment due to the damage caused to the liver. The biochemical data that presented significant differences in all animals compared to baseline were AST, ALT, GGT, FA, GLDH and serum protein. Creatinine did not change throughout the experiment. The results obtained suggest that liver alterations may occur throughout the three immunization cycles. There is a great need for new studies aimed at broadening knowledge about venom inoculation protocols in serum producer equines and minimizing the adverse effects of immunization. ABSTRACT challenge serotherapy Instituto Brazil antiBothrops anti cycles AST ALT GGT FA protein experiment

RESUMO: Acidentes ofídicos têm sido um desafio médico e veterinário. O único tratamento disponível e preconizado pela Organização Mundial da Saúde e pelo Ministério Saúde é a soroterapia. O presente estudo avaliou a função hepática dos equinos submetidos ao protocolo de imunização empregado atualmente pelo Instituto Vital Brazil para produção do soro antibotrópico. Foram avaliados cinco equinos com inoculação de veneno Botrópico durante o período de três ciclos de imunizações. Amostras de sangue foram coletadas para realização de exame bioquímico e avaliação hepática por conta das lesões causadas no fígado. Os dados bioquímicos que apresentaram diferenças significativas, em todos os animais, comparados ao tempo basal, foram AST, ALT, GGT, FA, GLDH e proteína sérica. Creatinina não apresentou alteração ao longo do experimento. Os resultados obtidos sugerem que ao longo dos três ciclos de imunização podem ocorrer alterações hepáticas. Há uma grande necessidade de novos estudos com objetivo de ampliar o conhecimento acerca dos protocolos de inoculação de veneno nos equinos soroprodutores e minimizar os efeitos adversos da imunização. RESUMO veterinário soroterapia antibotrópico imunizações fígado significativas animais basal AST ALT GGT FA sérica experimento hepáticas

RESUMO: Bothrops atrox é a serpente mais comum na Amazônia, e seu veneno provoca alterações locais e sistêmicas. Este relato descreve os achados clínico-patológicos e laboratoriais de ofidismo por Bothrops em seis equídeos no Pará, Brasil. Os animais, que pertenciam a cinco propriedades rurais diferentes, apresentaram sinais clínicos de apatia, anorexia e aumento da sensibilidade ao toque em áreas de aumento de volume. Três animais foram picados na parte distal dos membros pélvicos e três na região da cabeça. Os animais afetados na área dos membros pélvicos apresentaram edema acentuado que se estendia do boleto até a coxa e exibiam dificuldade de locomoção. Aqueles afetados na região da cabeça exibiam aumento de volume que conferia a aparência de uma “cabeça de rinoceronte”, bem como escurecimento da mucosa dos lábios e gengivas. Todos os animais apresentaram taquicardia e taquipneia, e os achados laboratoriais de dois animais evidenciaram anemia, leucocitose, aumento do tempo de coagulação e aumento das enzimas hepáticas (AST e GGT) e renais (ureia e creatinina). O tratamento foi ineficaz, e três dos quatro animais tratados faleceram. A necropsia foi realizada em três animais e foi observada hemorragia extensa no tecido dos locais da picada da serpente e líquido sanguinolento incoagulável nas cavidades. Observou-se congestão no diafragma, na serosa do intestino delgado e áreas mais claras na superfície renal. A histopatologia mostrou degeneração muscular, necrose, necrose tubular aguda, hemorragia e cilindros hialinos nos rins. Este relato destaca os achados clínico-patológicos de picada de serpente em equídeos. Além disso, parece ser o primeiro relato de envenenamento por Bothrops em uma mula no Brasil. RESUMO Amazônia sistêmicas clínicopatológicos clínico patológicos Pará Brasil diferentes apatia locomoção rinoceronte, rinoceronte , rinoceronte” gengivas taquipneia anemia leucocitose AST GGT ureia creatinina. creatinina . creatinina) ineficaz faleceram cavidades Observouse Observou diafragma renal muscular aguda rins disso

ABSTRACT: Bothrops atrox is the most common viper in the Amazon, and its venom causes local and systemic changes. This report describes the clinicopathological and laboratory findings of ophidism due to Bothrops in six horses in Pará, Brazil. The animals, which belonged to five different rural properties, showed clinical signs of apathy, anorexia, and increased touch sensitivity in areas of increased volume. Three animals were bitten in the distal part of the pelvic limbs and three in the head area. The affected animals in the distal limb area exhibited marked edema extending from the fetlock to the thigh and had difficulty moving. Those affected in the head region exhibited an increase in volume that gave the appearance of a “rhinoceros head,” as well as blackening of the mucosa of the lips and gums. All animals exhibited tachycardia and tachypnea, and laboratory findings of two animals showed anemia, leukocytosis, increased clotting time, and elevated liver (AST and GGT) and kidney enzymes (urea and creatinine). Treatment was ineffective, and three of four treated animals died. Necropsy was performed on three animals, revealing extensive hemorrhage in the tissues at the snake bite sites and incoagulable bloody fluid in the cavities. Congestion was observed in the diaphragm, in the serosa of the small intestine, and in lighter areas on the renal surface. Histopathology showed muscle degeneration, necrosis, acute tubular necrosis, hemorrhage, and hyaline casts in the kidneys. This case report highlights the clinicopathological findings of snakebite in horses. In addition, this seems to be the first report of bothropic envenom in a mule in Brazil. ABSTRACT Amazon changes Pará Brazil properties apathy anorexia moving rhinoceros head, gums tachypnea anemia leukocytosis time AST GGT urea creatinine. creatinine . creatinine) ineffective died cavities diaphragm intestine surface degeneration necrosis kidneys addition

Resumen La mordedura de serpientes Bothrops spp. y el ataque cerebrovascular isquémico tienen una patogenia compleja. Se reconocen efectos locales como edema, dolor, enrojecimiento y necrosis, así como manifestaciones sistémicas como trastornos de la coagulación, trombosis, insuficiencia renal y hemorragia, por lo que el accidente cerebrovascular hemorrágico es una complicación neurológica común, pero, en cambio, el accidente cerebrovascular isquémico es poco conocido. Se presenta el caso de un paciente de 50 años, sin comorbilidades, remitido de una zona rural del suroccidente de Colombia debido a la mordedura de una serpiente Bothrops spp. en su mano izquierda. En el momento del ingreso, el paciente presentaba deterioro de la conciencia y requirió asistencia respiratoria mecánica. Mediante resonancia magnética, se observaron múltiples áreas isquémicas bilaterales en la región fronto-temporal y en la occipital. Dos meses después, el paciente había evolucionado favorablemente, pero persistían la paresia en los pares craneales III y VI y el signo de Babinski. La fisiopatología del accidente cerebrovascular isquémico por mordedura de serpiente es compleja. La actividad procoagulante de los componentes del veneno, el choque hipovolémico, el daño endotelial y la tromboinflamación pueden explicar el accidente cerebrovascular isquémico que, aunque raro, debe considerarse como una complicación del accidente ofídico causado por serpientes Bothrops spp.

Abstract Bothrops spp. envenomation and its relationship with ischemic stroke has complex pathogenesis. Local effects such as edema, pain, redness, necrosis, and systemic manifestations like coagulation disorders, thrombosis, renal failure, and hemorrhage have been reported. Hemorrhagic stroke is a common neurological complication but ischemic stroke is poorly understood. We present here the case of a 50-year-old male with no comorbidities referred from a rural area in southwest Colombia with a Bothrops spp. snakebite on the left hand. On admission, the patient presented with a deterioration of consciousness and required mechanical ventilation assistance. The MRI showed multiple ischemic areas in the bilateral frontal- temporal and occipital regions. Two months later, the patient had a favorable resolution, although central paresis in the III and VI cranial nerves and positive Babinski’s sign persisted. As already mentioned, the pathophysiology of ischemic stroke due to snakebite is complex but the procoagulant activity of the venom components, the hypovolemic shock, the endothelial damage, and the thromboinflammation can explain it, and although it rarely occurs, it should be considered as a complication of ophidian accidents caused by Bothrops spp.

Resumen: El accidente ofídico es la lesión resultante de la mordedura de una serpiente, posteriormente, si se ha inoculado veneno se desarrollarán las alteraciones locales y/o sistémicas que en su conjunto reciben el nombre de ofidiotoxicosis. En el ámbito mundial, se calcula que cada año se registran 5.4 millones de accidentes ofídicos, lo cual genera de 81,000 a 131,000 muertes por ofidiotoxicosis. En México, durante 2019 se registraron 4,115 mordeduras por serpiente, afectando principalmente a hombres en edad reproductiva; sin embargo, se estima que exista un subregistro considerable en toda la región. Huixquilucan es un municipio del Estado de México que se ubica al poniente de la Ciudad de México. Debido a que la mayor parte de su territorio es ocupado por bosque de coníferas, entre las especies de importancia toxicológica se pueden encontrar vipéridos como Crotalus ravus (cascabel pigmea) y Crotalus triseriatus (cascabel transvolcánica), ya que este entorno representa uno de sus principales hábitats. Presentamos dos casos de pacientes pediátricos que desarrollaron ofidiotoxicosis en el municipio de Huixquilucan en momentos diferentes, los cuales fueron tratados exitosamente con el faboterápico antiviperino.

Abstract: Ophidian accident is the injury resulting from a snake bite, in which if venom has been inoculated, local and/or systemic alterations will develop, these alterations are named ophidiotoxicosis. Worldwide, it is estimated that 5.4 million ophidian accidents are recorded each year, which generates between 81,000 and 131,000 deaths from ophidiotoxicosis. In Mexico, during 2019, 4,115 snake bites were registered, mainly affecting men, however, it is estimated that there is a considerable under-registration throughout the region. Huixquilucan is a municipality in the State of Mexico that is located west of Mexico City. Most of its territory is occupied by coniferous forests, so among the species of toxicological importance can be found viperids such as Crotalus ravus and Crotalus triseriatus, since this environment represents one of its main habitats. We report two pediatric cases with snake envenomation by Crotalus ravus in Huixquilucan at different times, which were successfully treated with fabotherapy.

Resumo A mordedura de cobra é uma questão de saúde pública negligenciada, potencialmente fatal, causada por toxinas presentes no venoso da cobra. O veneno botrópico tem importantes efeitos fisiopatológicos, com lesões locais e ação proteolítica, bem como ativação da cascata da coagulação, consumo de fibrinogénio, levando a eventos hemorrágicos. Neste artigo, apresentamos o caso de um homem de 61 anos que foi mordido por uma cobra na coxa esquerda, e evoluiu com hipotensão, letargia, náuseas e vómitos. A tomografia computorizada do crânio, tórax, abdome e pelve demonstrou hemorragia intracerebral no lobo frontal esquerdo, hemorragia subaracnóidea bilateral, hemotórax esquerdo moderado e edema nas partes moles, no local das mordeduras da cobra na coxa esquerda. Apesar do tratamento adequado, o paciente morreu no quarto dia de hospitalização. É importante que o radiologista da emergência reconheça corretamente os achados das imagens e o acidente ofídico como causa das manifestações hemorrágicas.

Abstract Snakebite envenoming is a neglected public health issue, which is potentially life-threatening, caused by toxins present in the bite of a venomous snake. Bothropic venom has important physiopathological effects, with local lesions and proteolytic action, as well as coagulation cascade activation, consumption of fibrinogen, leading to hemorrhagic events. In this article, we present the case of a 61-year-old man who was bitten by a snake on his left thigh, and evoluted with hypotension, lethargy, nausea, and vomiting. Computed tomography of the brain, chest, abdomen, and pelvis demonstrated intracerebral hemorrhage in the left frontal lobe, bilateral subarachnoid hemorrhage, moderate left hemothorax and soft tissue edema at the site of the snakebites on the left thigh. Despite adequate treatment, the patient died on the fourth day of hospitalization. It is important that the emergency radiologist correctly recognize the imaging findings and the ophidian accident as the cause of the hemorrhagic manifestations.

Abstract Introduction: Ophidian accident is a global public health problem. In Mexico, there is a high incidence of snakebites, which cause medical complications that can leave severe sequelae. Objective: To analyze the epidemiological overview of snake venom poisoning in the Baja California (BC) peninsula within the 2003-2018 period. Method: A descriptive, retrospective analysis of reported cases was carried out, based on data collection and interpretation. Results: A total of 541 records were obtained, out of which 273 occurred in BC and 268 in Baja California Sur (BCS), with an annual average of 17.06 and 16.75, respectively. The incidence rate for BC was 7.62, while for BCS it was 33.09. The highest annual incidence rate in the state of BC corresponded to southern Ensenada, with a value of 42.3, while in BCS it corresponded to the municipality of Comondú, with a value of 54.04. Conclusions: Epidemiological analyses allow a better local, state and regional understanding of the problem, in order to develop efficient action protocols to face an ophidian accident, as well as to determine the training requirements of medical personnel and establish a support network for the treatment of cases.

Resumen Introducción: El accidente ofídico es un problema de salud pública mundial. En México existe una alta incidencia de mordeduras por serpientes, que provocan complicaciones médicas que pueden dejar secuelas severas. Objetivo: Analizar el panorama epidemiológico del ofidismo en la península de Baja California (BC) en los años 2003-2018. Método: Se hizo un análisis de tipo descriptivo y retrospectivo de los casos presentados, a partir de la recopilación e interpretación de la información. Resultados: Se obtuvieron 541 registros, de los cuales 273 se presentaron en BC y 268 en Baja California Sur (BCS), con un promedio anual de 17.06 y 16.75 respectivamente. La tasa de incidencia para BC fue de 7.62 y para BCS de 33.09. La tasa de incidencia anual más alta en el Estado de BC correspondió al sur de Ensenada, con un valor de 42.3, mientras que en BCS fue en Comondú, con un valor de 54.04. Conclusiones: Los análisis epidemiológicos permiten tener un mejor entendimiento local, estatal y regional de la problemática, para poder desarrollar protocolos de acción eficientes para enfrentar un accidente ofídico, así como para determinar las necesidades de capacitación del personal médico y establecer una red de ayuda para el tratamiento de casos.

Abstract The Bothrops genus is responsible for more than 95% of ophidian accidents in Argentina, most of these are reported in the Northeast and Northwest provinces. Bothrops alternatus, is the most frequent species of the genus Bothrops (yarará), themost southern large-scale viperid in the world and one of the most important species in Argentina, being able to be found in rela-tion to urban nucleus. Their characteristic features are kidney-like figures in the skin, that mimic phone tubes or beans, completeor incomplete, until the merged form. It presents a loreal pit, thermoreceptor organ located between the eye and the nostril. Itsdentition is solenoglyphous, hollow inoculating teeth, with closed duct, fixed to a mobile maxillary bone. Although variationsbetween animals are described, it is considered a monotypic species. The identification of this snake is important due their abun-dance in around urban regions and its frequency of finding.

Resumen El género Bothrops (yarará) es responsable de más del 95% de los accidentes por ofidios venenosos en Argentina. La mayoría de éstos son notificados en provincias del Nordeste y Noroeste. Bothrops alternatus, es la especie más frecuentementehallada, siendo el vipérido de gran talla más meridional del mundo y una de las especies de mayor importancia sanitaria en Argentina, pudiendo hallarse en relación a núcleos urbanos. Presentan en el dorso figuras arriñonadas características, que remedan atubos de teléfono o porotos unidos, completos o incompletos, hasta la forma fusionada. Presenta foseta loreal, órgano termore-ceptor ubicado entre el ojo y la fosa nasal. Su dentición es solenoglifa, dientes inoculadores huecos, con conducto cerrado, fijosa un hueso maxilar móvil. Si bien se describen variaciones entre animales, se considera una especie monotípica. Su identificaciónes importante dada la abundancia de especímenes y de hallazgos en regiones periurbanas.

ABSTRACT Ophidism is an accident with serious consequences for people linked to the ophidian accident that ends with sequelae such as organic damage and death. A snake was captured in the district of Las Piedras, Madre de Dios, Peru. The specimen was taken to the laboratory and it was taxonomically classified as Bothrocophias hyoprora. This finding was anecdotal because B. hyoprora is a poorly identified species in snake accidents and in populated areas, as it prefers areas of primary forest.

RESUMEN El ofidismo es un accidente con graves consecuencias para las personas vinculado al accidente ofidiano que termina con secuelas como daño orgánico y muerte. Una víbora fue capturada y llevada al laboratorio en el distrito de Las Piedras, Madre de Dios, Perú. Al realizar la clasificación taxonómica se le consideró como Bothrocophias hyoprora. Este hallazgo es anecdótico debido a que B. hyoprora es una especie mal identificada en accidentes de ofidios y en áreas pobladas, ya que prefiere áreas de bosques primarios.

ABSTRACT Introduction: In Peru, ophidian accidents are an important public health problem due to a wide territorial distribution of different types of snakes. Objective: To describe the clinical-epidemiological characteristics and the management of ophidian accidents registered in a hospital in Peru. Methods: Case series study carried out between January 2011 to December 2015 at the Santa Rosa Hospital in Puerto Maldonado, 256 medical records of patients with a definitive diagnosis of ophidism were reviewed. Sociodemographic and clinical variables and the evolution of the patients were analyzed. Results: A total of 78.5% of patients were men, the age group most affected were adults. Most of the accidents occurred in March (12.5%). 39% of the patients were engaged in agricultural work. Between 4:00 p.m. and 7:59 p.m., 35.2% of the accidents occurred. 71.1% reported the Bothrops atrox snake as the cause of the accident. 71.5% of the bites occurred on the lower limbs. Most patients received specific treatment with polyvalent anti-botropic (90.6%). Conclusions: In the studied population, the most affected sex is the male with an age between 27 and 59 years. The most frequent snake causing the accidents was the Bothrops atrox, better known among the inhabitants as “jergón”. In most cases, antivenom was administered as a specific treatment.

RESUMEN Introducción: En el Perú, los accidentes ofídicos son un importante problema de salud pública, debido a una amplia distribución territorial de diferentes tipos de serpientes. Objetivo: Describir las características clínico - epidemiológicas y el manejo de los accidentes ofídicos registrados en un hospital de Perú. Métodos: Estudio de serie de casos, realizado entre enero del 2011 a diciembre 2015 en el Hospital Santa Rosa de Puerto Maldonado. Se revisaron 256 historias clínicas de pacientes con diagnóstico definitivo de ofidismo. Se analizaron variables sociodemográficas, clínicas y evolución de los pacientes. Resultados: El 78,5 % de pacientes fueron varones, el grupo de edad más afectado fueron los adultos. La mayoría de los accidentes ocurrieron en el mes de marzo (12,5 %). Un 39 % de los pacientes se dedicaba al trabajo agrícola. Entre las 16:00 y 19:59 horas se produjeron 35,2 % de los accidentes, 71,1 % reportó como causante del accidente a la serpiente Bothrops atrox. El 71,5 % de las mordeduras se presentaron en miembros inferiores. La mayoría de pacientes recibió tratamiento específico con antibotrópico polivalente (90,6 %). Conclusiones: En la población estudiada, el sexo más afectado es el masculino con una edad entre 27 a 59 años. La serpiente más frecuente causante de los accidentes fue la Bothrops atrox, más conocida entre los pobladores como “jergón”. En la mayoría de los casos se administró como tratamiento específico el suero antiofídico.

Resumen El accidente ofídico representa un importante problema de salud pública en las zonas tropicales y subtropicales del mundo. La cascabel común (Crotalus durissus cumanensis) es la serpiente del género Crotalus más abundante en Venezuela. El objetivo fue determinar los cambios séricos en la alanino aminotransferasa (ALT), aspartato aminotransferasa (AST), lactato deshidrogenasa (LDH) y creatina fosfocinasa (CK) en ratas, inducidos por el veneno de Crotalus durissus cumanensis, así como el establecimiento de los efectos histopatológicos. Se prepararon cinco grupos experimentales con tres ratas cada uno, reservando un grupo control placebo (G1), el cual fue tratado por ruta IP con 100 µL de solución salina fisiológica estéril (SSFe). Al resto de los animales se les administraron 50 µg de veneno nativo por la misma vía. Estos fueron sacrificados a las 1 (G2), 3 (G3), 6 (G4) y 9 (G5) horas posinoculación, con tomas de muestras séricas para determinaciones de las referidas enzimas y de diferentes órganos para estudios histopatológicos (corazón, músculo esquelético, hígado y riñón). Se observó un incremento en la ALT (p < 0,005) a partir de la primera hora posinyección, con un pico a la novena hora de 147 ± 8 UI/L; para la AST (p < 0,005) a partir de la primera hora posinyección con concentración pico a la sexta hora (293 ± 8 UI/L). De la LDH (p < 0,005) se registró un pico máximo de 2700 ± 8 UI/L a la novena hora posinyección. La CK (p < 0,005) mostró un pico máximo de concentración a la sexta hora (1489,66 ± 8,5 UI/L). Los resultados histopatológicos en tejido cardíaco mostraron hiperemia, congestión y necrosis de Zenker; en músculo esquelético, hiperemia, infiltrado inflamatorio, necrosis de Zenker; en hígado, extravasación de glóbulos rojos, congestión de sinusoides, telangiectasia e infiltrado inflamatorio en vena centrolobulillar. El riñón mostró hemorragia en túbulos contorneados, infiltrado inflamatorio, colapso de los túbulos hasta la pérdida de la arquitectura del órgano. Los efectos observados fueron tiempo-dependientes. Los resultados pueden indicar un posible efecto miotóxico y hepatotóxico.

Abstract The ophidian accident represents a major public health problem in the tropical and subtropical areas of the world. The common rattlesnake (Crotalus durissus cumanensis) is the most abundant snake of the genus Crotalus in Venezuela. The objective was to determine the serum changes in alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine phosphokinase (CK) in rats, induced by the poison of Crotalus durissus cumanensis, as well as the establishment of histopathological effects. Five experimental groups were prepared with 3 rats each, reserving a placebo control group (G1), which was treated by IP route with 100 µL of sterile Physiological Saline Solution (SSFe), the rest of the animals were administered 50 µg of venom native by the same route, which were sacrificed at 1 (G2), 3 (G3), 6 (G4) and 9 (G5) hours post-inoculation, with serum samples taken for determinations of said enzymes, as well as different orgns for histopathological studies (heart, skeletal muscle, liver and kidney). An increase in ALT (p <0.005) was observed from the first hour post injection, with a peak at the ninth hour of 147 ± 8 IU / L; for AST (p <0.005) from the first hour post-injection with peak concentration at the sixth hour (293 ± 8 IU / L); with respect to LDH (p <0.005), a maximum peak of 2700 ± 8 IU / L was recorded at the ninth hour post-injection. CK (p <0.005) registered a maximum concentration peak at the sixth hour (1489.66 ± 8.5 IU / L). Histopathological results in cardiac tissue showed Zenker hyperemia, congestion, and necrosis; in skeletal muscle hyperemia, inflammatory infiltrate, Zenker's necrosis; in liver extravasation of red blood cells, sinus congestion, telangiectasia and inflammatory infiltrate in the centrilobular vein; the kidney showed hemorrhage in contoured tubules, inflammatory infiltrate, collapse of the tubules until loss of the organ architecture. The observed effects were time-dependent. The results could indicate a possible myotoxic and hepatotoxic effect.

Resumo Introdução O envenenamento por picada de serpentes é um latente problema de saúde pública em nível global. Neste contexto, o Brasil se apresenta como referência mundial no tratamento deste tipo de acidente. É importante destacar que o tratamento de acidentes ofídicos no país foi evidenciado a partir dos estudos do sanitarista Vital Brazil, que patenteou o tratamento e doou para o Estado brasileiro. Mas, qual o impacto este ato gerou para a sociedade, já que a gestão da patente se tornou obrigação do Estado? Objetivo A partir de uma análise da evolução do tratamento do ofidismo, verificar a correlação entre os investimentos do Governo Federal nos principais institutos responsáveis pela produção do soro e realização de pesquisas para o tratamento de acidentes ofídicos no Brasil, com relação ao número de vítimas fatais dos acidentes. Método Realizou-se uma análise de correlação estatística, tendo como base acidentes e óbitos decorrentes dos acidentes ofídicos e os investimentos do governo nos principais institutos produtores de soros antipeçonhentos, no período de 1998 a 2017. Resultados Os resultados mostraram que há uma franca evolução no número de acidentes decorrentes dos acidentes ofídicos no Brasil entre 1998 e 2017. Conclusão Existe correlação positiva entre os investimentos do Governo Federal nos principais institutos responsáveis pela produção do soro e realização de pesquisas para o tratamento de acidentes ofídicos no Brasil, com relação ao número de vítimas fatais dos acidentes.

Abstract Background Snakebite poisoning is a latent global public health problem. In this context, Brazil is a world reference in the treatment of this type of accident. It is important to highlight that the treatment of ophidian accidents in the country was evidenced by the studies of the sanitary veterinarian Vital Brazil, who patented the treatment and donated to the Brazilian state. But what impact did this act have on society since patent management became a state obligation? Objective Based on an analysis of the evolution of the treatment of ophidism, we aimed to verify the correlation between the investments of the Federal Government in the main institutes responsible for the production of serum and researching the treatment of ophidian accidents in Brazil, number of fatal accident victims. Method A statistical correlation analysis was performed based on accidents and deaths resulting from ophidian accidents and government investments in the main institutes producing anti-blind sera from 1998 to 2017. Results The results showed that there is a clear evolution in the number of accidents resulting from ophidian accidents in Brazil. Conclusion there is a positive correlation between the investments of the Brazilian government to control the mortality resulting from these accidents.

Resumen En el departamento del Tolima no hay estudios que permitan precisar con certeza la magnitud del accidente ofídico causado por Crotalus durissus, existiendo la necesidad de generar información sobre el perfil proteico, como forma de aproximación a la compresión de algunas actividades biológicas relacionadas con la toxicidad del veneno, así como su potencial biotecnológico. En este trabajo se analizó el perfil electroforético por SDS-PAGE del veneno crudo extraído de individuos colectados en el municipio de Natagaima (Tolima) y la asociación con actividades fosfolipasa, hemolítica directa e indirecta y bactericida sobre Escherichia coli, Staphylococcus aureus y Pseudomona aeuroginosa. El veneno crudo presentó bandas de peso molecular 26.6 kDa., 17, 14.2, 6.5, 3.5 y 1.06 kDa., correspondientes con otros reportes previos del veneno para la especie. Se presentaron niveles considerables de actividades hemolítica (200 μg) y fosfolipasa (1.25 UA/mg. ± 0.88) dependientes de Calcio, y el efecto bactericida del veneno crudo fue diferencial sobre los microorganismos evaluados, presentando actividad moderada sobre Escherichia coli. Los resultados constituyen datos valiosos que confieren un acercamiento hacia el conocimiento del potencial tóxico del veneno de Crotalus durissus (cascabel) de la zona de Natagaima-Tolima, así como de la capacidad bactericida y posibles aplicaciones futuras en campos de investigación relacionados con la búsqueda de nuevos agentes antimicrobianos.

Abstract In the department of Tolima, there are no studies that allow us to determine with certainty the magnitude of the ophidian accident caused by Crotalus durissus, and there is a need to generate information on the protein profile, as a way of approaching the compression of some biological activities related to the toxicity of the venom, as well as its biotechnological potential. In this work, the SDS-PAGE electrophoretic profile of the crude venom extracted from individuals collected in the municipality of Natagaima (Tolima) and the association with phospholipase, direct and indirect hemolytic and bactericidal activities on Escherichia coli, Staphylococcus aureus and Pseudomonas aeuroginosa were analysed. The crude venom presented bands of molecular weight 26.6 kDa., 17, 14.2, 6.5, 3.5 and 1.06 kDa., corresponding to other previous reports of the venom for the specie. Considerable levels of calcium-dependent-hemolytic (200 μg) and phospholipase (1.25 AU/mg. ± 0.88) activities were presented, and the bactericidal effect of the crude venom was differential on the microorganisms evaluated, showing moderate activity on Escherichia coli. The results constitute valuable data that confer an approach towards the knowledge of the toxic potential of the venom of Crotalus durissus (rattlesnake) from the Natagaima-Tolima area, as well as the bactericidal capacity and possible future applications in research fields related to the search for new antimicrobial agents.

Abstract Human envenomation by the snakes Colubridae and Dipsadidae are reported in Brazil, and envenomation by the Opisthoglyphous snake Philodryas olfersii could be dangerous. Here, we present the second record of an envenomation by Philodryas olfersii in Pernambuco, northeast Brazil. The male victim presented with mild erythema pain, paraesthesia, local numbness, and swollen lymph nodes. The symptoms were similar to those of a pit viper bite, and disappeared completely after 15 days.

Resumen Introducción. El ofidismo es un relevante problema de salud pública y, en Colombia, se incluyó como un evento de notificación obligatoria desde el año 2004. Por ser un país tropical con gran diversidad ecosistémica, ocupa el tercer puesto en Latinoamérica, después de México y Brasil, en presentar el mayor número de accidentes ofídicos. Objetivo. Realizar un análisis retrospectivo del accidente ofídico en el departamento de Nariño, con base en los eventos notificados entre los años 2008 y 2017 al Instituto Departamental de Salud de Nariño y al Sistema de Vigilancia en Salud Pública de Colombia. Materiales y métodos. Se hizo un análisis de tipo descriptivo y retrospectivo a partir de la recopilación e interpretación de la información consignada en las fichas de notificación para accidente ofídico del Instituto Departamental de Salud de Nariño, entre los años 2008 y 2017. Se representó la frecuencia del accidente ofídico a nivel municipal mediante la elaboración de un mapa y se identificaron los géneros responsables del mismo. Resultados. Se reporta un total de 1.110 casos. El 78,13 % de los municipios hizo alguna notificación. Se observa un patrón de aumento constante en el número de casos durante los 10 años, a excepción de 2017. Las características sociodemográficas se mantuvieron durante el periodo de estudio. Conclusiones. El municipio de San Andrés de Tumaco, el sexo masculino y las áreas rurales son los principales afectados por el ofidismo causado, en mayor medida, por el género Bothrops. La mayor incidencia se presentó en el mes de julio.

Abstract Introduction. Snakebite envenoming is a relevant public health problem, and, in Colombia, it was included as a mandatory notification event since 2004. Because it is a tropical country with great ecosystem diversity, it occupies third place in Latin America, after Mexico and Brazil, reaching the highest number of snakebites. Objective. To carry out a retrospective analysis of snakebites in the department of Nariño based on the notifications reported to the Instituto Departamental de Salud de Nariño and the Sistema de Vigilancia en Salud Pública de Colombia between the years 2008 and 2017. Materials and methods. A descriptive and retrospective analysis was carried out based on the study, and interpretation of the information contained in the notification sheets for ophidian accidents of the Instituto Departamental de Salud de Nariño between the years 2008 and 2017. The snakebite frequency at the municipal level was represented by the elaboration of a map and the responsible genus were identified. Results. A total of 1,110 cases were reported for ophidian accidents. Seventy- eight point thirteen per cent of the municipalities made some notification. A pattern of constant increase in the case number during the 10 years is evident, with exception of 2017; the sociodemographic characteristics are maintained. Conclusions. The municipality of San Andrés de Tumaco, the masculine gender and the rural areas are mostly affected by snakebites, caused mainly by the Bothrops genus and the highest snakebite incidence was seen in July.