ABSTRACT Scorpion envenoming is considered a public health problem in Brazil. A recent study described a variation in the clinical outcome of envenoming by Tityus obscurus in two populations separated by 850 km in the northeastern Amazon region. Our aim was to evaluate whether such clinical and toxinological variations are associated with underlying differences in genetic diversity between these two T. obscurus populations. We obtained DNA from five individuals of each population, in the municipalities of Belém and Santarém, located east and west of the state of Pará, Brazil, respectively. Gene regions encoding mitochondrial DNA (mtDNA) markers cytochrome oxidase subunit I (COI) and ribosomal 16S RNA (16S) were amplified and sequenced. Phylogenetic analyses were performed using maximum likelihood (ML) and Bayesian inferences (BA) for both molecular data (COI and 16S). The sampled T. obscurus populations corresponded to two distinct mtDNA lineages (genetic distance COI K2 P = 0.08 to 0.13; 16S K2 P = 0.10 to 0.11) with no shared mutations between groups and well supported by ML and BA inferences. Based on the divergence values found between eastern and western populations (COI, 0.07 to 0.12; 16S, 0.10), our study confirms the genetic heterogeneity of T. obscurus populations within the state of Pará, which correlates with observed venom and clinical differences, and reinforces the need for mapping the distribution of haplotypes throughout the geographic range of T. obscurus, to aid in future epidemiological, toxinological, and evolutionary studies.

RESUMO O envenenamento por escorpiões é considerado um problema de saúde pública no Brasil. Um estudo recente descreve a variação do quadro clínico de envenenamento por Tityus obscurus em duas populações separadas por uma distância de 850 km no nordeste da Amazônia. O objetivo deste estudo foi avaliar se tais variações clínicas e toxicológicas estão associadas a diferenças subjacentes na diversidade genética entre essas duas populações de T. obscurus. Obtivemos DNA de cinco indivíduos de cada população nos municípios de Belém e Santarém, localizados a leste e oeste do estado do Pará, Brasil, respectivamente. Regiões gênicas que codificam marcadores de DNA mitocondrial (mtDNA) citocromo oxidase subunidade I (COI) e RNA ribossômico 16S (16S) foram amplificadas e sequenciadas. As análises filogenéticas foram realizadas por máxima verossimilhança (ML) e inferência Bayesiana (BA) para ambos os dados moleculares (COI e 16S). As populações de T. obscurus amostradas corresponderam a duas linhagens distintas de mtDNA (distância genética COI K2 P = 0,08 a 0,13; 16S K2 P = 0,10 a 0,11) sem mutações compartilhadas entre os grupos, e bem corroboradas por inferências ML e BA. Com base nos valores de divergência encontrados entre as populações oriental e ocidental (COI, 0,07 a 0,12; 16S, 0,10), nosso estudo confirma a heterogeneidade genética das populações de T. obscurus no estado do Pará. Os resultados são congruentes com as diferenças observadas no quadro clínico dos acidentes e toxicidade do veneno, e reforçam a necessidade de mapear a distribuição de haplótipos em toda a distribuição geográfica de T. obscurus, para auxiliar em futuros estudos epidemiológicos, toxinológicos e evolutivos.

Resumen: El escorpionismo, como se denomina al cuadro clínico producido por la picadura de escorpiones tóxicos en humanos, es un problema de salud pública en áreas urbanas y rurales de la América Tropical, incluyendo Paraguay, asociado a pobreza y a la falta de acceso a antivenenos específicos. Aunque su prevalencia en Paraguay no ha sido aún evaluada, la presencia de especies de reconocida toxicidad que son propias del país junto a otras especies compartidas con los países limítrofes y el registro de envenenamientos severos en niños en el Departamento Central, demandan la revisión de esta patología para su conocimiento por los profesionales de salud y de investigación sobre el tema. En esta revisión, se describen el conocimiento actual sobre esta patología en Paraguay, las alteraciones fisiopatológicas ocasionadas por los componentes tóxicos presentes en el veneno escorpiónico en los principales sistemas fisiológicos que sirven de blanco farmacológico de las toxinas, además de aportar a su diagnóstico diferencial, con el fin de contribuir con el adecuado tratamiento de las víctimas de estos envenenamientos y a la comprensión holística de esta emergente enfermedad desatendida en el país.

Abstract: Scorpionism, or the medical consequence of scorpion stings in humans, is a public health problem in urban and rural areas of Tropical America, including Paraguay, associated with poverty and the lack of access to specific antivenoms. Despite its prevalence, scorpionism in Paraguay has not been assessed before. The local distribution of toxic scorpion species that are endemic to Paraguay and shared with neighboring countries, and also the record of severe cases in children from the Central Department, demand a review of this pathology to enlighten health professionals and biomedical researchers on the subject. In this review, the current status of scorpionism in Paraguay is presented, along with the physiopathological alterations elicited by scorpion venoms on the various organ systems targeted by the toxins, and its differential diagnosis, with the intent to contribute with the adequate treatment of victims and the holistic understanding of this emerging neglected disease in the country.

A leishmaniose visceral (LV) é um problema de saúde pública nas cidades brasileiras. Por mais que haja um planejamento de políticas públicas para LV no Estado de São Paulo, Brasil, novos casos têm sido notificados e se disseminado. O artigo objetiva discutir como o Centro de Controle de Zoonoses realiza suas atividades espacialmente em uma cidade endêmica, Presidente Prudente, no Estado de São Paulo. Os dados são da Secretaria Municipal de Saúde de Presidente Prudente, Instituto Adolfo Lutz e Instituto Brasileiro de Geografia e Estatística. Estimamos espacialmente a população canina por setor censitário e utilizamos ferramentas de geoprocessamento para produzir mapas coropléticos, tendências espaciais e autocorrelação espacial. Encontramos um padrão espacial de maior prevalência na periferia da cidade e uma autocorrelação espacial positiva estatisticamente significativa (I = 0,2; p < 0,000) com clusters de relação alta-alta no noroeste da cidade. Além disso, identificamos uma direção diferente no caminho dos inquéritos sorológicos realizados versus a tendência na LV canina, o que enfatiza a fragilidade das medidas de controle do Centro de Controle de Zoonoses para controlar casos da doença. O Centro de Controle de Zoonoses parece estar sempre correndo atrás da doença. A análise espacial pode ser útil para repensar o funcionamento do serviço e auxiliar as políticas públicas.

Visceral leishmaniasis (VL) is a public health problem in Brazilian municipalities. As much as there is a planning of public policies regards VL in São Paulo State, new cases have been reported and spread. This paper aims to discuss how the Center for Zoonoses Control conducts its actions spatially in endemic city of Presidente Prudente, São Paulo State. Data are from the Municipal Health Department of Presidente Prudente, Adolfo Lutz Institute, and Brazilian Institute of Geography and Statistics. We spatially estimated the dog population per census tract and used geoprocessing tools to perform choropleth maps, spatial trends, and spatial autocorrelation. We found a spatial pattern of higher prevalence in the city’s outskirt and a positive statistically significant spatial autocorrelation (I = 0.2, p-value < 0.000) with clusters of high-high relationships in the Northwest part of the city. Moreover, we identified a different direction in the path of the conducted serosurveys versus the canine VL trend, which stresses the fragility of the Center for Zoonoses Control actions to control the disease. The Center for Zoonoses Control always seems to chase the disease. The spatial analysis may be useful for rethinking how the service works and helps in public policies.

La leishmaniasis visceral (LV) es un problema de salud pública en las ciudades brasileñas. Aunque hay políticas públicas de planificación relacionadas con la LV en el estado de São Paulo, Brasil, se han informado de nuevos casos, además de su propagación. El objetivo de este trabajo es discutir cómo el Centro de Control de Zoonosis dirige sus acciones espacialmente en una ciudad endémica del estado de São Paulo, Presidente Prudente. Los datos proceden de la Secretaría Municipal de Salud de Presidente Prudente, del Instituto Adolfo Lutz, y del Instituto Brasileño de Geografía y Estadística. Estimamos espacialmente la población de perros por sector censal y utilizamos herramientas de geoprocesamiento para elaborar mapas de coropletas, tendencias espaciales, y autocorrelación espacial. Encontramos un patrón espacial de más alta prevalencia en la periferia de la ciudad, además de una autocorrelación espacial positiva y estadísticamente significativa (I = 0,2; valor de p < 0,000) con clústeres de relaciones alto-alto en la parte noroccidental de la ciudad. Además, identificamos una dirección diferente en la trayectoria de las encuestas serológicas llevadas a cabo, frente a la tendencia de LV canina, que enfatiza la debilidad de acciones del Centro de Control de Zoonosis para controlar casos de la enfermedad. El Centro de Control de Zoonosis parece siempre estar tras la enfermedad. El análisis espacial podría ser útil para repensar cómo está funcionando el servicio, además de ayudar a políticas públicas.

A leishmaniose visceral (LV) é um problema de saúde pública nas cidades brasileiras. Por mais que haja um planejamento de políticas públicas para LV no Estado de São Paulo, Brasil, novos casos têm sido notificados e se disseminado. O artigo objetiva discutir como o Centro de Controle de Zoonoses realiza suas atividades espacialmente em uma cidade endêmica, Presidente Prudente, no Estado de São Paulo. Os dados são da Secretaria Municipal de Saúde de Presidente Prudente, Instituto Adolfo Lutz e Instituto Brasileiro de Geografia e Estatística. Estimamos espacialmente a população canina por setor censitário e utilizamos ferramentas de geoprocessamento para produzir mapas coropléticos, tendências espaciais e autocorrelação espacial. Encontramos um padrão espacial de maior prevalência na periferia da cidade e uma autocorrelação espacial positiva estatisticamente significativa (I = 0,2; p < 0,000) com clusters de relação alta-alta no noroeste da cidade. Além disso, identificamos uma direção diferente no caminho dos inquéritos sorológicos realizados versus a tendência na LV canina, o que enfatiza a fragilidade das medidas de controle do Centro de Controle de Zoonoses para controlar casos da doença. O Centro de Controle de Zoonoses parece estar sempre correndo atrás da doença. A análise espacial pode ser útil para repensar o funcionamento do serviço e auxiliar as políticas públicas.

Visceral leishmaniasis (VL) is a public health problem in Brazilian municipalities. As much as there is a planning of public policies regards VL in São Paulo State, new cases have been reported and spread. This paper aims to discuss how the Center for Zoonoses Control conducts its actions spatially in endemic city of Presidente Prudente, São Paulo State. Data are from the Municipal Health Department of Presidente Prudente, Adolfo Lutz Institute, and Brazilian Institute of Geography and Statistics. We spatially estimated the dog population per census tract and used geoprocessing tools to perform choropleth maps, spatial trends, and spatial autocorrelation. We found a spatial pattern of higher prevalence in the city’s outskirt and a positive statistically significant spatial autocorrelation (I = 0.2, p-value < 0.000) with clusters of high-high relationships in the Northwest part of the city. Moreover, we identified a different direction in the path of the conducted serosurveys versus the canine VL trend, which stresses the fragility of the Center for Zoonoses Control actions to control the disease. The Center for Zoonoses Control always seems to chase the disease. The spatial analysis may be useful for rethinking how the service works and helps in public policies.

La leishmaniasis visceral (LV) es un problema de salud pública en las ciudades brasileñas. Aunque hay políticas públicas de planificación relacionadas con la LV en el estado de São Paulo, Brasil, se han informado de nuevos casos, además de su propagación. El objetivo de este trabajo es discutir cómo el Centro de Control de Zoonosis dirige sus acciones espacialmente en una ciudad endémica del estado de São Paulo, Presidente Prudente. Los datos proceden de la Secretaría Municipal de Salud de Presidente Prudente, del Instituto Adolfo Lutz, y del Instituto Brasileño de Geografía y Estadística. Estimamos espacialmente la población de perros por sector censal y utilizamos herramientas de geoprocesamiento para elaborar mapas de coropletas, tendencias espaciales, y autocorrelación espacial. Encontramos un patrón espacial de más alta prevalencia en la periferia de la ciudad, además de una autocorrelación espacial positiva y estadísticamente significativa (I = 0,2; valor de p < 0,000) con clústeres de relaciones alto-alto en la parte noroccidental de la ciudad. Además, identificamos una dirección diferente en la trayectoria de las encuestas serológicas llevadas a cabo, frente a la tendencia de LV canina, que enfatiza la debilidad de acciones del Centro de Control de Zoonosis para controlar casos de la enfermedad. El Centro de Control de Zoonosis parece siempre estar tras la enfermedad. El análisis espacial podría ser útil para repensar cómo está funcionando el servicio, además de ayudar a políticas públicas.

ABSTRACT Background: Guillian Barré syndrome (GBS) is an acute autoimmune polyradiculoneuropathy often associated with previous exposure to infectious agents. Methods: A clinical cohort of 41 patients with GBS admitted to the Base Hospital Institute of the Federal District between May 2017 and April 2019 was followed up for 1 year. Serological tests for arbovirus detection and amplification of nucleic acids using polymerase chain reaction for zika virus (ZIKV), dengue virus (DENV), and chikungunya virus (CHIKV) were performed. Results: The cohort consisted of 61% men with a median age of 40 years, and 83% had GBS-triggering events. A total of 54% had Grade 4 disability, 17% had Grade 3, 12% had Grade 2, 10% had Grade 5, and 7% had Grade 1. The classic form occurred in 83% of patients. Nerve conduction evaluations revealed acute demyelinating inflammatory polyneuropathy (51%), acute motor axonal neuropathy (17%), acute sensory-motor neuropathy (15%), and indeterminate forms (17%). Four patients were seropositive for DENV. There was no laboratory detection of ZIKV or CHIKV infection. Ninety percent of patients received human immunoglobulin. Intensive care unit admission occurred in 17.1% of the patients, and mechanical ventilation was used in 14.6%. One patient died of Bickerstaff’s encephalitis. Most patients showed an improvement in disability at 10 weeks of follow-up. Conclusions: GBS in the Federal District showed a variable clinical spectrum, and it was possible to detect recent exposure to DENV.

Abstract Tityus trivittatus is considered the most medically important scorpion species of southern South America. In this contribution we redefine its taxonomy, redescribe the species and separate the southern popula tions as a new species, Tityus carrilloi n. sp. As a consequence of this description, the most medically important species of the region turns out to be the new species herein described. We also clearly establish the phylogenetic position of both species through a dated molecular phylogenetic analysis based on four genes. Finally, we discuss the differences of the venom between the two species, and the epidemiologic implications of our results on the scorpionism problem in the region.

Resumen Tityus trivittatus es considerada la especie de escorpión de mayor importancia médica en el sur de Sudamérica. En este trabajo redefinimos su taxonomía, redescribimos esta especie y sepa ramos las poblaciones meridionales como una nueva especie Tityus carrilloi n. sp. Como consecuencia de esta descripción, la especie de mayor importancia médica de la región es la especie que describimos aquí. Establecemos además claramente la posición filogenética de ambas especies a través de una filogenia molecular datada basada en cuatro genes. Finalmente discutimos las diferencias del veneno entre ambas especies y las implicaciones epide miológicas de nuestros resultados sobre el problema del escorpionismo en la región.

Resumen Introducción. Los accidentes causados por animales venenosos ocurren con mucha frecuencia en comunidades pobres con acceso limitado a los servicios de salud. Se les consideran enfermedades desatendidas y son una de las causas importantes de morbimortalidad en varias naciones del mundo, incluida Venezuela. Objetivo. Evaluar la mortalidad por contacto traumático con animales venenosos (serie X20-X29) en Venezuela en el periodo de 2000 a 2009. Materiales y métodos. Los datos se obtuvieron de los anuarios de mortalidad del Ministerio de Salud. Resultados. Se registraron 759 decesos, la mayoría de ellos en el 2009. La primera causa fue la mordedura de serpientes (n=323; 42,6 %), seguida por la picadura de himenópteros (n=170; 22,4 %), la mordedura de centípedos (n=106; 14,0 %) y la picadura de escorpiones (n=76; 10,0 %). La mediana de la tasa de mortalidad general para el periodo fue de 0,285 fallecidos por 100.000 habitantes, en tanto que, por grupo específico, fue de 0,120 para ofidios, de 0,065 para himenópteros, de 0,035 para centípedos y de 0,025 para escorpiones. Conclusión. Al comparar estos datos con los antecedentes históricos, se evidenció la modificación del patrón de mortalidad en el país caracterizada por un aumento significativo de los decesos por centípedos, tercera causa de muerte, lo que reubica la picadura de escorpiones como la cuarta causa de mortalidad.

Abstract Introduction: Injuries by venomous animals frequently occur in impoverished communities with limited access to health services. They are considered neglected diseases that stand out as important causes of morbidity and mortality in various countries, including Venezuela. Objective: To assess mortalities resulting from contact with venomous animals in Venezuela from 2000 to 2009 (X20-X29 series). Materials and Methods: The data were obtained from the annual mortality records of the Venezuelan Ministry of Health. Results: From 2000-2009, 759 fatalities were recorded with the greatest number taking place in 2009. Snakebites (n=323; 42.6%) accounted for the largest percentage of envenomation-related deaths in that period, followed by hymenopteran stings (n=170; 22.4%), centipede bites (n=106; 14.0%), and scorpion stings (n=76; 10.0%). The median value of envenomation-related deaths per 100,000 inhabitants (period 2000-2009) was 0.285: 0.120 corresponded to snakebites, 0.065 to hymenopteran stings, 0.035 to centipede bites, and 0.025 to scorpion stings. Conclusions: Taking into account previous records of animal envenomations in Venezuela, we provided evidence for a shift in the pattern of mortality. Deaths due to centipede bites have increased, making it the third leading cause of envenomation-related mortality in Venezuela. Scorpionism, on the other hand, has declined to the fourth most common cause of fatal envenomations in the country.

Abstract Venom from Amazonian scorpions of the genus Tityus contains components capable of eliciting a distinct clinical, mostly neurological, syndrome. This contrasts with the mainly autonomic manifestations produced after envenomation by congeneric southern and northern South American species. Herein, we summarize Pan-Amazonian scorpionism by synthesizing available toxinological, clinical, and molecular data gathered from all affected areas in Amazonia, including Brazil, Ecuador, Colombia, Peru, Venezuela, and French Guiana. We searched multiple databases, as well as our own records, for reports of scorpion envenomations in Amazonia by confirmed Tityus spp., and compared the clinical manifestations. To help uncover clinical and venom relationships among problematic species, we explored phylogenetic relationships with a rate-calibrated analysis of mitochondrial COI data from available species. The possible existence of diversity gradients for venom toxic and immunogenic components despite the predicted strong phylogenetic association among species is underscored by discussed clinical and toxinological findings. A multicentric effort, involving all nations affected by this neglected disease, is urgently needed to offer alternatives for treating and understanding this pathology, including the preparation of neutralizing antibodies with a broad range of efficacy.

ABSTRACT Envenomation by poisonous snakes is frequent in Paraguay, particularly in the departments bordering with Brazil, and can be severe if the species involved belongs to the families Viperidae or Elapidae. It mostly affects 20-40 year old men involved in agricultural activities. Eastern Paraguay, together with southeast Brazil, has been identified as one of the highest snakebite incidence areas in the Neotropics. This review presents available epidemiological data and revises the physiopathology of the envenomation, particularly in the case of viperid venoms, as well as the current distribution of species in genera Bothrops and Micrurus in Paraguay. It posits the need to prepare a national reference venom based on Paraguay´s biodiversity to pave the way for testing the neutralization capacity of foreign antivenoms or for the preparation of a national snake antivenom.

RESUMEN El accidente ofídico en el Paraguay es un evento frecuente que reviste gravedad si la serpiente asociada pertenece a las familias Viperidae y Elapidae, particularmente en los departamentos fronterizos con el Brasil, en donde afecta principalmente a hombres en actividades agrícolas entre los 20 y 40 años de edad. El oriente del Paraguay, junto con el sudeste del Brasil, ha sido identificado como una de las áreas de mayor incidencia de ofidismo en todo el Neotrópico. Se presenta una revisión de la problemática desde el punto de vista epidemiológico y fisiopatológico, conjuntamente con la distribución de las especies de potencial importancia médica de los géneros Bothrops y Micrurus. Se plantea la necesidad de elaborar un veneno de referencia nacional que represente las especies asociadas a los envenenamientos severos y que permita la evaluación de la capacidad neutralizante de antídotos foráneos, así como la eventual preparación de un antiveneno nacional.

ABSTRACT Leishmaniasis and Chagas disease affect millions of people worldwide, particularly in Latin America where poor and vulnerable rural populations are mostly affected. Although joint efforts have been made to fight these neglected diseases, the combination of different factors such as inefficient treatment, lack of interest in investing in the search for new therapeutic sources, and the emergence of resistant strains of parasites end up complicating prospects. This situation makes it vitally important to develop new strategies aimed at identifying molecules with potential application in therapy or that may exert a synergistic effect when supplemented with current chemotherapy. One of the approaches proposed for this purpose is the search for these agents based on pharmacological targets present in the parasites causing Leishmaniasis and Chagas. Among these molecular targets there are enzymes involved in essential pathways of the parasite, such as Trypanothione Reductase (TR), involved in combating oxidative stress generated by reactive oxygen species produced by host macrophages during infection. An important tool in the search for inhibitors for this enzyme can be found in the application of in silico tools, which is a relatively inexpensive and fast method of selecting potential molecules from a variety of sources. Assays based on virtual screening allow the selection of molecules in a rational way, which through complementary tests can lead to the future emergence of new drugs.

RESUMEN La Leishmaniasis y la Enfermedad de Chagas afectan a millones de personas en América Latina y en otras regiones del mundo, siendo las poblaciones rurales pobres y vulnerables las más afectadas. Aunque se han realizado esfuerzos conjuntos para el combate de estas enfermedades desatendidas, la combinación de diferentes factores como el tratamiento ineficiente, la falta de interés para invertir en la búsqueda de nuevas fuentes terapéuticas y el surgimiento de cepas de parásitos resistentes acaban complicando las perspectivas. Esta situación torna de vital importancia el desarrollo de nuevas estrategias que apunten a la identificación de moléculas con potencial aplicación en la terapia o que puedan ejercer un efecto sinérgico cuando se complementan con la quimioterapia actual. Uno de los enfoques propuestos para este fin consiste en la búsqueda de estos agentes basados en blancos farmacológicos presentes en los parásitos causantes de las citadas enfermedades. Entre estos blancos moleculares se encuentran las enzimas implicadas en vías esenciales del parásito, como la Tripanotiona Reductasa (TR), involucrada en el combate al estrés oxidativo generado por las especies reactivas de oxígeno producidas por macrófagos del huésped durante la infección. Una herramienta importante en la búsqueda de inhibidores para esta enzima puede ser encontrada a través de la aplicación de herramientas in silico, que resulta un método relativamente rápido y de bajo costo, el cual permite seleccionar moléculas con potencial a partir de una gran variedad de fuentes. Los ensayos basados en el tamizaje (“screening”) virtual permiten la selección de moléculas de forma racional, que mediante ensayos complementarios pueden dar lugar al surgimiento futuro de nuevos fármacos.

ABSTRACT Scorpionism is the accident resulting from the envenomation of humans by toxic scorpions. It is considered a health public problem in several tropical and subtropical regions of the world, including the Americas. The extreme venom toxicity of some species belonging to the genus Tityus has prompted the preparation of specific antivenoms in Latin America, which use is considered the only efficacious therapeutic strategy for treating scorpionism. Paraguay is inhabited by three Tityus species of reknown toxicity in neighbouring Brazil and Argentina (T. trivittatus, T. confluens, and T. bahiensis) but their sanitary importance in the country remains unknown. This review updates the list of known scorpion species in Paraguay and their distribution, and also presents data on their toxicity, with the intent to arise interest in the subject considering the recording of severe accidents in children, the possible increase in the number of scorpionism cases in the country as a result of global warming, and the need to identify effective scorpion antivenoms in the country.

RESUMEN El escorpionismo, como se conoce al accidente producido por escorpiones tóxicos en humanos, es un problema de salud pública en varias regiones del mundo, incluyendo centros urbanos de la América Tropical. La elevada toxicidad de algunas de las especies del género Tityus ha demandado la preparación de antivenenos específicos en América Latina, única estrategia terapéutica eficaz para el tratamiento de estos accidentes. En Paraguay habitan tres especies del género (T. trivittatus, T. confluens y T. bahiensis) de reconocida peligrosidad en Argentina y Brasil, pero cuya real importancia sanitaria en el país es desconocida. Ante el registro de accidentes severos y el posible escenario de un incremento epidemiológico del escorpionismo en Paraguay producto del calentamiento global, esta revisión presenta las especies conocidas del país, su distribución y datos sobre su toxicidad, a fin de sentar las bases para un necesario estudio que aclare la real magnitud del problema en el país e identifique los antivenenos antiescorpiónicos efectivos en Paraguay.

Abstract The aim of this study was to investigate the influence of preheating and post-curing methods on diametral tensile strength (DTS), flexural strength (FS), knoop microhardness (KHN), and degree of conversion (DC) of an experimental fiber-reinforced composite (FRC). Specimens (30 wt% of 3-mm-short E-glass fiber, 22.5 wt% of methacrylated-based resin and 47.5 wt% of filler particles) were subjected to: P – photocuring at 1500 mW/cm2 for 40 s (control); P/M – photocuring and microwave post-curing (540W/5 minutes); P/A – photocuring and autoclave post-curing (120°C/15 minutes); PH-P – preheating (60°C) and photocuring; PH-P/M – preheating, photocuring and microwave post-curing; and PH-P/A – preheating, photocuring and autoclave post-curing. Specimens for DTS (Ø 3 x 6 mm) and FS (25 x 2 x 2 mm) were tested at Instron 5965. KHN employed a 50g load for 30s. DC was measured using FTIR spectroscopy. Statistical analysis employed: factorial analysis, normality test, one-way ANOVA and Tukey’s HSD test, independent T-test and the Dunnett test. Interaction between factors was not significant (P>0.05). Preheating promoted significantly higher values of FS and KHN (p = 0.0001). Post-curing promoted significantly higher values for KHN (p = 0.0001). For DTS (p = 0.066) and DC (p= 0.724) no statistical difference was found between groups. SEM images showed that preheating promoted better interaction between glass fibers and resin matrix. Preheating increased FS, KHN and DTS, and post-curing increased KHN. DC was not affected by both methods. Preheating and post-curing methods can be used to improve some mechanical properties of FRCs’ but degree of conversion remains unaffected.

ABSTRACT INTRODUCTION Despite their high toxicity, antimonials and amphotericin B deoxycholate are commonly used for treating visceral leishmaniasis (VL). Few studies showing conflictive data about their efficacy and adverse events in pediatric population are available. This study aimed to evaluate efficacy and safety of amphotericin B deoxycholate vs. that of N-methylglucamine antimoniate in treating pediatric VL in Brazil. METHODS This was a randomized, open-label, 2-arm and controlled pilot clinical trial. Treatment naïve children and adolescents with VL without signs of severe illness were treated with N-methylglucamine antimoniate (20mg/kg/day for 20 days) or amphotericin B deoxycholate (1 mg/kg/day for 14 days). All patients were diagnosed with positive direct examination and/or positive PCR for Leishmania spp. performed in bone marrow samples. The primary efficacy end-point was VL cure determined after 180 days of completion of treatment. The analysis was performed using intention-to-treat (ITT) and per protocol (PP) analyses. RESULTS In total, 101 volunteers were assessed. Efficacy was similar for both groups. The antimonial (n=51) and amphotericin B groups (n=50) had a cure rate of 94.1% and 100%, and 94% and 97.9% according to ITT and PP analyses, respectively. All patients reported adverse events (AE). Serious AE incidence was similar in both groups. Five individuals were excluded from the study because of severe adverse events. CONCLUSIONS N-methylglucamine antimoniate and amphotericin B deoxycholate have similar efficacy and adverse events rate in pediatric patients with VL.

En Venezuela, entren los años 2004 y 2009, los libros de morbilidad registraron oficialmente para el capítulo X de la Clasificación Estadística International de Enfermedades y Problemas Asociados a la Salud (CIE-10), res grupos o categorías de lesiones traumáticas con animales: a) exposición a fuerzas mecánicas animadas (mordeduras), presentadas como mordeduras sospechosas de rabia (con el código A82) y no con los códigos propuestos para este trabajo desde W53 hasta W59, b) picaduras de insectos y otros artrópodos abarcando todos los códigos desde X21 hasta X25 más X27 y c) “emponzoñamiento” ofídico registrado con los códigos X20 y 59. En total, se verificaron 674.554 accidentes por contacto con animales. La mayor frecuencia fue causada por mordeduras sospechosas de rabia (362.556; 53,7%), en segunda instancia las picaduras de insectos y otros rtrópodos (279.909; 41,5%) y finalmente los accidentes por ofidios (32.089; 4,8%). El año 2005 registró la mayor frecuencia de todos los accidentes (n = 160.793; 23,8%) para el periodo; además de la mayor frecuencia e mordeduras sospechosas de rabia (n = 85.796) y picaduras de insectos y otros artrópodos (n = 68.075). El mayor número de accidentes ofídicos (10.349) se observó en 2006. Las medianas de las tasas de morbilidad (calculadas para el periodo 2005-2009, por el método de Hodges y Lehmann), fueron de 257,84 casos por cada 100.000 habitantes para las mordeduras sospechosas de rabia, 201,89 para las picaduras de insectos y otros artrópodos y 22,71 para los accidentes por ofidios. Se encontraron diferencias estadísticamente significativas entre las tres causas etiológicas. La mediana que abarcó todas las causas de contacto con animales fue de 483,51 casos por cada 100.000 habitantes. Los datos demuestran que las causas externas que implicaron contacto con animales en territorio venezolano representan un problema de salud colectiva para el país.

In Venezuela, between 2004 and 2009, morbidity records taken from Chapter XX of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), refer to three categories of traumatic animal injuries: a) exposure to animated mechanical forces (bites), shown as suspicious rabies bites (code A82; not with the codes proposed in this study from W53 to W59), b) insect and other arthropod bites encompassing codes from X21 to X25 plus X27, and c) registered "poisoning" by snakebite (codes X20 and W59). In total, 674,554 accidents were recorded as produced from contact with animals. The highest frequency was caused by suspected rabies bites (362,556; 53.7%) followed by insect and other arthropod bites (279,909; 41.5%), and snakebites (32,089; 4.8%). The highest frequency of all accidents (n = 160,793; 23.8%) for the period corresponded to 2006, including suspected rabies bites (n = 85,796) and bites by insects and other arthropods (n = 68,075). The highest number of snakebite accidents (10,349) was observed in 2006. Median morbidity rates (per 100,000 inhabitants, calculated for the period 2005-2009 by the Hodges and Lehmann method) were 257.84 cases for suspected rabies bites, 201.89 cases for bites by insects and other arthropods, and 22.71 cases for snakebite accidents. Statistically significant differences between the three etiological causes were observed. The median encompassing all causes of contact with animals in Venezuela was 483.51 cases per 100,000 inhabitants. The data show that the external causes involving contact with animals in Venezuela represent a collective health problem in the country.

RESUMO Trata-se de uma reflexão que promove diálogo entre pressupostos da Educação Permanente em Saúde (EPS) e proposições desformadoras do poeta Manoel de Barros, com o objetivo de contribuir para a transvisão da formação e do trabalho em saúde. Optou-se por desvelar tal aproximação com base nos versos do poema “As lições de RQ”, que funcionaram como plataforma para os saltos reflexivos. A discussão encontrou respaldo principal em Paulo Freire e Adolfo Sanchez Vázquez, uma vez que caminhou na perspectiva de uma práxis revolucionária, transformadora e libertadora.

ABSTRACT This work serves as a theoretical construction promoting dialogue between the assumptions grounding permanent education in health (EPS) and the poet Manoel de Barros’ ‘disforming’ propositions, in order to contribute to views on training and working in health. We have decided to unveil such an approach from the verses of the poem “As Lições de RQ” (“The RQ Lessons”) that serve as the basis for reflective advances. The discussion is mainly based on the works of Paulo Freire and Adolfo Sánchez Vázquez, as it shifts toward a revolutionary, transformative and liberating praxis.