Abstract Introduction: The efficacy of 20-minute whole blood clotting (WBCT20) and the Lee-White clotting time (LWCT) tests in diagnosing coagulation alterations from snakebites were compared. Methods: We evaluated 89 snakebite cases treated at the Hospital Regional do Juruá em Cruzeiro do Sul, Acre, Brazil. Results: WBCT20 results were normal in 33.7% and unclottable in 66.3% of cases, while LWCT results were normal in 23.6% and altered (prolonged or unclottable) in 76.4% of cases, with no significant differences. Conclusions: The WBCT20 is important for rapidly diagnosing coagulation alterations from snakebites. Furthermore, it is efficient, inexpensive, and can be deployed in isolated hospitals.

RESUMO Este estudo aborda os aspectos clínicos e epidemiológicos dos envenenamentos ofídicos tratados em um hospital em Cruzeiro do Sul, Acre, resultantes de acidentes que ocorreram na região do Alto Juruá, no oeste da Amazônia brasileira. A identidade específica das serpentes que causaram os envenenamentos foi inferida (a) pelos sinais e sintomas apresentados pelo paciente na admissão hospitalar, (b) por imunoensaio enzimático para detecção de veneno de Bothrops atrox e Lachesis muta em amostras de soro retiradas de pacientes antes da soroterapia, e (c) pela identificação direta da serpente, quando esta foi levada para o hospital ou fotografada. Houve 133 casos (76,2 casos por 100.000 habitantes) de acidentes ofídicos registrados durante um ano (julho 2017 a junho 2018). A maioria das picadas de serpentes (88,7%) foi causada por Bothrops spp., e o restante por espécies não peçonhentas ou “picadas secas”. Os acidentes ofídicos tenderam a ocorrer com maior frequência durante a estação chuvosa, coincidindo com o período de maior atividade reprodutiva das serpentes e maior disponibilidade de suas presas. Além disso, o aumento dos níveis de rios e lagos pode fazer com que esses animais procurem locais mais secos, aumentando a frequência de encontro com seres humanos. Campanhas educativas sobre prevenção e primeiros socorros, principalmente entre os grupos mais vulneráveis (indígenas, agricultores, crianças e adolescentes em áreas rurais), e sobre a importância da utilização de equipamentos de proteção (botas, perneiras, luvas de couro) em determinadas atividades de maior risco (e.g., agricultura e extrativismo em florestas), são fundamentais para reduzir a morbidade de picadas de serpentes.

ABSTRACT This study addresses the clinical and epidemiological aspects of envenoming cases resulting from snakebites treated at a hospital in Cruzeiro do Sul, in the upper Juruá River region, western Brazilian Amazonia. The specific identity of snakes that caused the envenomings was inferred (a) from the diagnosis of patient symptoms and signs upon hospital admission, (b) by enzyme immunoassay for detection of Bothrops atrox and Lachesis muta venom from serum samples taken from patients before antivenom therapy, or (c) by direct identification of the snake, when it was brought along to the hospital or photographed. There were 133 snakebites (76.2 cases per 100,000 inhabitants) registered during one year (July 2017 to June 2018). Most snakebites (88.7%) were caused by Bothrops spp., and the rest by non-venomous snakes or dry bites. Snakebites tended to occur more often during the rainy season, coinciding with the period of greater reproductive activity of the snakes and greater availability of their prey. In addition, the increase in the water level of rivers and lakes during the rainy season tends to concentrate snakes in dry places and, thus, to increase encounters with humans. Information campaigns on prevention and first aid, specially among the most vulnerable groups (indigenous people, farmers, and children and teenagers in rural areas), and the importance of using protective equipment (boots, leggings, leather gloves) in certain high risk activities (e.g. agriculture and extractivism in forests) are fundamental for the reduction of snakebite morbidity.

Abstract INTRODUCTION: In this study, we examined the clinical manifestations, laboratory evidence, and the circumstances of snakebites caused by non-venomous snakes, which were treated at the Regional Hospital of Juruá in Cruzeiro do Sul. METHODS: Data were collected through patient interviews, identification of the species that were taken to the hospital, and the clinical manifestations. RESULTS: Eight confirmed and four probable cases of non-venomous snakebites were recorded. CONCLUSIONS: The symptoms produced by the snakes Helicops angulatus and Philodryas viridissima, combined with their coloration can be confused with venomous snakes (Bothrops atrox and Bothrops bilineatus), thus resulting in incorrect bothropic snakebite diagnosis.

Abstract INTRODUCTION: We present here the risk from snakebites because of palm extractivism in western Amazonia. METHODS: The data were extracted from a cross-sectional sample study, from January 2016 to April 2018, at the Juruá Regional Hospital of Cruzeiro do Sul (Acre). RESULTS: There were 14 Bothrops incidents involving males, most of them occurring during the harvesting of “açaí” (Euterpe precatoria). CONCLUSIONS: During the harvesting of “açaí,” there is the risk of the presence of B. atrox on the ground near the palm tree, and of B. bilineatus at the top of the palm tree.