Search

Background Snakebite is an often-neglected event with a high rate of mortality and is concentrated in poor areas. We aimed to assess the economic impact and health effects of the implementation of interventions for snakebites through a systematic review of the scientific literature. Methods Thirty search strategies were conducted in seven databases, applying PRISMA's identification, screening, selection, and inclusion phases. The reproducibility of the selection of studies and the extraction of information were guaranteed. The methodological quality was evaluated using the Consolidated Health Economic Evaluation Reporting Standards. Qualitative synthesis and meta-analysis were performed for determining the average cost-effectiveness (ACE) for each death and disability-adjusted life years (DALY) avoided. Results Six cost-effectiveness studies were included for the supply of antivenom (AV), taken as outcomes on days of hospitalization or in ICU, death and DALYs avoided. All studies only included institutional costs, and majority of them did not specify the analytical model or economic evaluation parameters and did not perform uncertainty analyses. The management protocol standardization with interdisciplinary attention improves ACE of AV. Cost-effectiveness ratio (CER) of treatment with AV was USD 1253 (constant value for the year 2017, adjusted by purchasing power parity) for each death avoided and USD 51 per DALY avoided. Conclusion High cost-effectiveness of the AV treatment for snakebites was evidenced, which shows that the allocation of resources for this event should be a healthcare priority in addition to implementation of strategies that improve the access to, opportunity, and quality of hospital and pre-hospital care and reduce the cost of AV.

The Buenavista landfill is located east of the city of Medellín, but it has a slope steeper than 30% and is less than 600 m away from the Piedras River, possibly influencing the quality of the drinking water in the city. Many complex residues are disposed of in this landfill, including pharmaceuticals and personal care products (PPCPs) such as levonorgestrel (LNG), which may reach water bodies via runoff and leaching. We assessed the levels of LNG in the effluent of an upflow anaerobic sludge blanket (UASB) reactor from the Buenavista landfill by uHPLC–DAD, as well as the endocrine disruptor effect of LNG on placental cell lines (BeWo) and human sperm cells. Additionally, the potential leaching of LNG was assayed under laboratory conditions using soil layers that were sampled from the Buenavista landfill. LNG was detected at levels of 315 μg·L−1 in the effluents of the UASB reactor. Thus, the UASB reactor is not an efficient treatment method for the removal of recalcitrant pollutants. Additionally, we found that a layer of soil used as a cover material may adsorb more than 90% of LNG pollutants, but small amounts may still be leached, which means that a cover material is not a strong enough barrier to fully prevent the leaching of LNG. Finally, our results show that the leachate fraction decreased the levels of β-human chorionic gonadotropin, but not sperm motility or viability. Thus, leached LNG could trigger reproduction disorders, but further studies should be carried out to investigate its potential effects in more detail.

espanolIntroduccion: el mesotelioma epitelioide es un tumor que se desarrolla en las capas embrionarias mesoteliales; es de etiologia desconocida, pero se relaciona con la exposicion al asbesto. Tiene una presentacion clinica inespecifica y un pronostico de sobrevida corto despues del diagnostico. Presentacion del caso: hombre de profesion mecanico automotor, con tos sin expectoracion, disnea, hipertermia y emaciacion posterior a la extraccion quirurgica de lipomas que afectaban el torax, quien posteriormente fue diagnosticado con mesotelioma epitelioide maligno con ubicacion en la pleura del hemitorax derecho y fue tratado con toracotomia, quimioterapia con los medicamentos pemetrexed y cisplatino y sesiones de radioterapia, que mostraron un aumento en la sobrevida 3 tres anos. Conclusion: este caso permitio identificar que el uso de la pleurodesis quimica con quimioterapia como tratamiento podria ser responsable del aumento de la esperanza de vida y la calidad de esta en los pacientes que padecen este tipo de tumor. EnglishIntroduction: Epithelioid mesothelioma is a tumor that develops in the mesothelial embryonic layers; it is of an unknown etiology, but it is related to asbestos exposure with a nonspecific clinical presentation and a short survival prognosis after diagnosis. Case presentation: An automotive mechanic patient presents with cough without expectoration, dyspnea, hyperthermia, and emaciation following surgical removal of lipomas. This affected the chest and the patient was subsequently diagnosed with malignant epithelioid mesothelioma located in the pleura of the right hemithorax. The patient was treated with thoracotomy, chemotherapy with the drugs pemetrexed and cisplatin, and radiation therapy sessions which resulted in an increased survival rate at 4 years. Conclusion: This case report identifies the use of chemical pleurodesis in combination with chemotherapy as an effective treatment for increasing the life expectancy and quality of life in patients suffering from this type of tumor. portuguesIntroducao: o mesotelioma epitelioide e um tumor que se desenvolve nas camadas embrionarias mesoteliais; e de causa desconhecida, mas esta relacionado com a exposicao ao amianto e possui uma manifestacao clinica inespecifica e com prognostico de sobrevivencia curto apos o diagnostico. Apresentacao do caso: o paciente e um mecânico automotivo, que apresentou tosse seca, dispneia, hipertermia e emagrecimento posterior a extracao cirurgica de lipomas que afetavam o torax sendo posteriormente diagnosticado com mesotelioma epitelioide maligno localizado na pleura do hemitorax direito e foi tratado com toracotomia, quimioterapia com os medicamentos pemetrexed e cisplatino alem de sessoes de radioterapia, mostrando um aumento de expectativa de vida para 4 anos. Conclusao: este estudo de caso permite identificar que o uso da pleurodese quimica com quimioterapia como tratamento poderia ser a responsavel pelo aumento da expectativa e qualidade de vida em pacientes acometidos por este tipo de tumor.

New evidence suggests that glycan expression in placental cells of women with invasive disorders of pregnancy differs from that in normal pregnant women. Hypothesizing that modifications of glycan expression could account for the course of preeclampsia, we established placental villous histocultures and compared glycan expression in women with preeclampsia with that in normal pregnant women and also in syncytialized BeWo cells, and we tested the effect of glycan expression on the functional phenotypes of circulating natural killer (NK) cells. Histocultures of third-trimester placentae from women with preeclampsia and full-term placentae from healthy pregnant women and BeWo choriocarcinoma cells were assessed for the expression of terminal glycans by lectin-binding assays. Circulating NK cells from nonpregnant healthy donors were tested in vitro for their cytotoxic activity and intracellular cytokine content. Histocultures from women with preeclampsia expressed significantly more mannose than did those from healthy pregnant women. Both histocultures and BeWo cells expressed terminal fucose, mannose, sialic acid, and N -acetylgalactosamine, although mean fluorescence intensity (MFI) expression was lower in choriocarcinoma cells than in cells from histocultures. Cocultures of circulating NK cells with K562 target cells resulted in a dose-dependent cytotoxicity effect, but the use of BeWo cells as target reduced cytotoxic activity; this reduction was not affected by syncytialization. Histocultures of placental villous tissue of women with preeclampsia expressed high levels of terminal mannose. We proposethat placental glycans may modulate the functional activity of circulating NK cells in the context of systemic inflammatory response in preeclampsia.

Introducción. Los venenos de serpientes representan una fuente importante de proteínas y péptidos, los cuales exhiben diversas actividades biológicas, tales como antibacterianas, antiparasitarias, antivirales, antitumorales, antifúngicas y contra la agregación plaquetaria, entre otras. Las fosfolipasas A2 presentes en los venenos de serpientes son las proteínas más estudiadas en estos modelos. Se ha demostrado que las fosfolipasas A2, activas e inactivas, poseen actividad catalítica contra células tumorales. Objetivo. Aislar, purificar y caracterizar la fosfolipasa A2 del veneno de Crotalus durissus cumanensis para evaluar su actividad antitumoral in vitro. Materiales y métodos. El aislamiento, la purificación y la identificación de la crotoxina B se hizo mediante la cromatografía de exclusión molecular, la cromatografía líquida de alto rendimiento de fase inversa (Reversed Phase High-Performance Liquid Chromatography, RP-HPLC) y la espectrometría de masas. El efecto citotóxico sobre células tumorales (K562) y células normales (células mononucleares de sangre periférica) se determinó utilizando la técnica de MTT. Resultados. La separación y posterior identificación de la crotoxina B del veneno de C. d. cumanensis de Colombia, permitieron evidenciar que esta fosfolipasa A2 posee efecto citotóxico sobre las células mononucleares de sangre periférica con una dosis de 18,23 ± 0,57 μg/ml, mientras que, para las células K562, fue de 2,34 ± 0,199 μg/ml. Conclusiones. Los resultados sugieren la posibilidad de utilizar la crotoxina B aislada del veneno de C. d. cumanensis como un posible recurso terapéutico para su aplicación en humanos. Palabras clave: Crotalus durissus cumanensis; citotoxicidad; fosfolipasas A2; crotoxina B.

The presence of levonorgestrel (LNG) in water bodies via direct discharge and human excretion has been reported worldwide, but its effects on the reproduction of aquatic species and humans are still unknown. Owing to its recalcitrant properties, LNG is not completely removed during wastewater treatment plants, and many species may be exposed to low traces of this compound from discharged effluents. Thus, in this study, a photocatalytic process for removing LNG along with screening of endocrine disruptor effects for risk assessment was applied. Although the removal rate of LNG by ultraviolet C (UV-C) radiation was >90%, reproductive toxicity testing using the BeWo cell line exposed to LNG and its degraded fraction showed the reduced production of basal human chorionic gonadotropin hormone (β-hCG) by more than 73%, from 8.90 mIU mL-1 to

ABSTARCT: The polysaccharide heparan sulfate is ubiquitously expressed as a proteoglycan in extracellular matrices and on cell surfaces. In the glomerular filtration barrier, the action of the heparan sulfate is directly related to the function of glomerular filtration, mostly attributed to the sulfated domains that occur along the polysaccharide chain, as evidenced by fact that release of fragments of heparan sulfate by heparanase significantly increases the permeability of albumin passage through the glomerular endothelium, event that originates proteinuria. This review aims to show the importance of the structural domains of heparan sulfate in the process of selective permeability and to demonstrate how these domains may be altered during the glomerular inflammation processes that occur in preeclampsia.

We report the first biochemical, biological, pharmacological and partial proteomic characterization studies of the Opisthancanthus elatus venom (Gervais, 1844) from Colombia. The Reverse Phase High-Performance Liquid Chromatography venom profile showed 28 main well-defined peaks, most eluting between 20 and 45min (18-30% of acetonitrile, respectively). High-resolution mass analysis indicates the presence of 106 components ranging from 806.59742Da to 16849.4139Da. O. elatus venom showed hemolytic activity and hydrolyzed the specific substrate BapNa suggesting the presence of proteins with serine-protease activity. Collected RP-HPLC fractions eluting at 52.6, 55.5, 55.8, 56.2, and 63.9min (PLA2 region between 33 and 40% of acetonitrile), showed hemolytic activity and hydrolyzed the synthetic substrate 4-nitro-3-octanoyloxy-benzoic acid, indicating the presence of compounds with phospholipases A2 activity. These RP-HPLC fractions, showed molecular masses values up to 13978.19546Da, corroborating the possible presence of the mentioned enzymes. Tryptic digestion and MS/MS analysis showed the presence of a phospholipase like fragment, similar to on described in other Opisthacanthus genus studies. No coagulant activity was observed. No larvicidal or antimicrobial activity was observed at concentrations evaluated. Lethal and toxic activity is expected at doses above 100mg/kg, no neurotoxic effects were detected at lower doses. In conclusion, O. elatus exhibits a venom with a predominant phospholipase A2 activity than thought; mammal's neurotoxic activity is expected above the 100mg/kg, which is very high compared to the venom from other neurotoxic scorpions.

The Colombian rattlesnake Crotalus durissus cumanensis is distributed in three geographic zones of the country: the Atlantic Coast, the upper valley of the Magdalena River, and the eastern plains of the Colombian Orinoquía. Its venom induces neurological symptoms, such as eyelid ptosis, myasthenic facies, and paralysis of the respiratory muscles, which can lead to death. Identification and analysis of C. d. cumanensis showed nine groups of proteins responsible for the neurotoxic effect, of which the crotoxin complex was the most abundant (64.71%). Immunorecognition tests of C. d. cumanensis showed that the use of a commercial antivenom manufactured in Mexico resulted in immunoreactivity. COL0007631 COL0007524 COL0014476

RESUMEN: En animales de pastoreo, el reporte de accidentes ofídicos es muy bajo y, además, presenta un amplio subregistro. A pesar de esto, es de gran utilidad conocer la incidencia de estos accidentes, pues son de gran importancia por las pérdidas económicas que pueden causar en el sector pecuario. Los accidentes por serpientes venenosas, tanto de la familia Viperidae como Elapidae, en caballos y ganado vacuno son frecuentes en muchos lugares del mundo, debido al aumento en la destinación de las tierras para la actividad ganadera. Colombia no es ajena a ello; sin embargo, el registro de este tipo de accidentalidad es muy bajo. En los diferentes reportes de accidentes ofídicos en animales, se ha observado que las principales manifestaciones sistémicas están caracterizadas por complicaciones cardiacas, hemodinámicas y neurotóxicas. Igualmente, se observan efectos locales, los cuales se caracterizan por presencia de hemorragias locales, edema y necrosis. El tratamiento específico utilizado en los accidentes por serpientes es la seroterapia, que consta de inmunoglobulinas G (Sueros IgG) completas o fraccionadas (Faboterápicos Fab o Fab2), específicas para un género o especie. ABSTRACT: The report of ophidic accidents in grazing animals is very low, and it is also widely under recorded. In spite of this, it is of great use to know the incidence of these accidents, as they are very important due to the economic loss they may cause to the livestock sector. Accidents caused by poisonous snakes from the Viperidae and Elapidae families in horses and in cattle are very frequent in many parts of the world, given the increase in land destination for lives tock. Colombia’s case is no different; however, the report of this type of accidents is very low. In the different reports of ophidic accidents in animals, it is observed that the main systemic manifestations are characterized by cardiac, hemodynamic and neurotoxic complications. Likewise, local effects are observed, mainly characterized by the presence of local bleeding, edema and necrosis. The specific treatment used in accidents caused by snakes is serothera py, which consists of full or fractional immunoglobulin G (IgG Serum) (Fabotherapics Fab or Fab2), specific for a gender or a species. COL0014476

Introducción: Colombia es un país con dos productores de antivenenos de IgG, pero hay un mercado insatisfecho por diferentes razones técnicas. Objetivos: evaluar la eficacia y la seguridad de un antiveneno F(ab´)2 polivalente (Antivipmyn-Tri®) producido en México, y un nuevo esquema de dosis en accidente bothrópico en Colombia. Métodos: se realizaron durante 9 meses un ensayo clínico-terapéutico y cuantificaciones de veneno y antiveneno sérico (ELISA) en 53 pacientes. Resultados: cuarenta y cuatro pacientes fueron mordidos por Bothrops asper en Antioquia y Chocó y 9 por B. atrox en Amazonas; todos tenían sangre incoagulable al ingreso, 30 (56,6%) con sangrado local y 24 (45,3%) con sangrado sistémico. El grado final de envenenamiento fue leve en 13 (24,5%), moderado en 30 (56,6%) y grave en 10 pacientes (18,9%). A las dosis recomendadas de 5 frascos para los casos leves o moderados y 10 para los graves, Antivipmyn-Tri® fue 100% eficaz para disminuir significativamente las concentraciones séricas de veneno en la primera hora de tratamiento y para detener el sangrado en las primeras 6-12 horas, 96,2% eficaz para normalizar la coagulación en 24 horas y 100% en 48 horas. Hubo 2 casos (3,8%) de recurrencia de coagulopatía sin sangrado y 12 recurrencias de antigenemia sin implicaciones clínicas. Diez pacientes (18,9%) presentaron reacciones tempranas adversas (leves) a la faboterapia. No hubo muertes, y cuatro pacientes (7,5%) tuvieron secuelas. Conclusión: a las dosis utilizadas en este estudio, Antivipmyn-Tri® fue eficaz y seguro para el tratamiento del envenenamiento bothrópico en Colombia. Introduction: Colombia is a country with two whole IgG antivenom producers, but the expectancy of all the market are not fulfilled by different technical reasons. Objectives: To evaluate the efficacy and safety of a F(ab´)2 polyvalent antivenom produced in Mexico and of a new dosage regimen for Bothrops bites in Colombia. Methods: A clinical trial, including serum venom and antivenom measurements (ELISA), was performed during 9 months in 53 patients. Results: forty four patients were bitten by Bothrops asper in Antioquia and Chocó and 9 by B. atrox in Amazonas; on admission, all of them had nonclottable blood, 30 (56.6%) presented local and 24 (45.3%) systemic bleeding. The final envenoming grade was mild in 13 (24.5%), moderate in 30 (56.6%) and severe in 10 patients (18.9%). At the antivenom doses used in this study (5 vials for mild / moderate and 10 for severe envenoming), Antivipmyn Triwas 100% efficient to decrease significantly serum venom concentrations within the first treatment hour, and to stop local and systemic bleeding within 6-12 hours, 96.2% efficient to restore blood coagulation within 24 hours and 100% within 48 hours. Two patients (3.8%) had recurrence of coagulopathy without bleeding, and there were 12 recurrences of antigenaemia without clinical relevance. Ten (18.9%) patients suffered early mild adverse reactions to fabotherapy. There were no deaths and four patients (7.5%) presented sequelae. Conclusion: at the doses used in this study, Antivipmyn Tri® was efficient and safe for the treatment of Bothrops bites in Colombia.

Introduction: Colombia is a country with two whole IgG antivenom producers, but the expectancy of all the market are not fulfilled by different technical reasons. Objectives: To evaluate the efficacy and safety of a F(ab´)2 polyvalent antivenom produced in Mexico and of a new dosage regimen for Bothrops bites in Colombia. Methods: A clinical trial, including serum venom and antivenom measurements (ELISA), was performed during 9 months in 53 patients. Results: forty four patients were bitten by Bothrops asper in Antioquia and Chocó and 9 by B. atrox in Amazonas; on admission, all of them had nonclottable blood, 30 (56.6%) presented local and 24 (45.3%) systemic bleeding. The final envenoming grade was mild in 13 (24.5%), moderate in 30 (56.6%) and severe in 10 patients (18.9%). At the antivenom doses used in this study (5 vials for mild / moderate and 10 for severe envenoming), Antivipmyn Triwas 100% efficient to decrease significantly serum venom concentrations within the first treatment hour, and to stop local and systemic bleeding within 6-12 hours, 96.2% efficient to restore blood coagulation within 24 hours and 100% within 48 hours. Two patients (3.8%) had recurrence of coagulopathy without bleeding, and there were 12 recurrences of antigenaemia without clinical relevance. Ten (18.9%) patients suffered early mild adverse reactions to fabotherapy. There were no deaths and four patients (7.5%) presented sequelae. Conclusion: at the doses used in this study, Antivipmyn Tri® was efficient and safe for the treatment of Bothrops bites in Colombia. Introducción: Colombia es un país con dos productores de antivenenos de IgG, pero hay un mercado insatisfecho por diferentes razones técnicas. Objetivos: evaluar la eficacia y la seguridad de un antiveneno F(ab´)2 polivalente (Antivipmyn-Tri®) producido en México, y un nuevo esquema de dosis en accidente bothrópico en Colombia. Métodos: se realizaron durante 9 meses un ensayo clínico-terapéutico y cuantificaciones de veneno y antiveneno sérico (ELISA) en 53 pacientes. Resultados: cuarenta y cuatro pacientes fueron mordidos por Bothrops asper en Antioquia y Chocó y 9 por B. atrox en Amazonas; todos tenían sangre incoagulable al ingreso, 30 (56,6%) con sangrado local y 24 (45,3%) con sangrado sistémico. El grado final de envenenamiento fue leve en 13 (24,5%), moderado en 30 (56,6%) y grave en 10 pacientes (18,9%). A las dosis recomendadas de 5 frascos para los casos leves o moderados y 10 para los graves, Antivipmyn-Tri® fue 100% eficaz para disminuir significativamente las concentraciones séricas de veneno en la primera hora de tratamiento y para detener el sangrado en las primeras 6-12 horas, 96,2% eficaz para normalizar la coagulación en 24 horas y 100% en 48 horas. Hubo 2 casos (3,8%) de recurrencia de coagulopatía sin sangrado y 12 recurrencias de antigenemia sin implicaciones clínicas. Diez pacientes (18,9%) presentaron reacciones tempranas adversas (leves) a la faboterapia. No hubo muertes, y cuatro pacientes (7,5%) tuvieron secuelas. Conclusión: a las dosis utilizadas en este estudio, Antivipmyn-Tri® fue eficaz y seguro para el tratamiento del envenenamiento bothrópico en Colombia.

The spiders of world-wide medical importance belong to thePhoneutria, Loxosceles, Latrodectus and Atrax genera, thefirst genus being only distributed from Costa Rica to Bolivia.Atrax genus is found in Australia, New Guinea and SalomonIslands. Spider bites in America are a public health problemin some countries such as Chile, United States and Brazil,being those inflicted by Loxosceles spp more frequent inChile and in the United States, and those by Phoneutria sppin Brazil. In Colombia, there are no reports of bites byLoxosceles spp. Nevertheless, bites by Latrodectus spp werereported during the first half of XXth century and Phoneutriaspp spider bites occurred in Antioquia during the 1990s. Inthis paper, a review of the taxonomic, toxinologic and clinicalaspects of aracnidism, is presented allowing us to be alertfor their correct diagnosis and treatment.

RESUMEN: Objetivos: Objetivos: evaluar la eficacia y la seguridad de un antiveneno F (ab´)2 polivalente (Antivipmyn-Tri®) producido en México, y un nuevo esquema de dosis en accidente bothrópico en Colombia. Métodos: se realizaron durante 9 meses un ensayo clínico-terapéutico y cuantificaciones de veneno y antiveneno sérico (ELISA) en 53 pacientes. Resultados: cuarenta y cuatro pacientes fueron mordidos por Bothrops asper en Antioquia y Chocó y 9 por B. atrox en Amazonas; todos tenían sangre incoagulable al ingreso, 30 (56,6%) con sangrado local y 24 (45,3%) con sangrado sistémico. El grado final de envenenamiento fue leve en 13 (24,5%), moderado en 30 (56,6%) y grave en 10 pacientes (18,9%). A las dosis recomendadas de 5 frascos para los casos leves o moderados y 10 para los graves, Antivipmyn-Tri® fue 100% eficaz para disminuir significativamente las concentraciones séricas de veneno en la primera hora de tratamiento y para detener el sangrado en las primeras 6-12 horas, 96,2% eficaz para normalizar la coagulación en 24 horas y 100% en 48 horas. Hubo 2 casos (3,8%) de recurrencia de coagulopatía sin sangrado y 12 recurrencias de antigenemia sin implicaciones clínicas. Diez pacientes (18,9%) presentaron reacciones tempranas adversas (leves) a la faboterapia. No hubo muertes, y cuatro pacientes (7,5%) tuvieron secuelas. Conclusión: a las dosis utilizadas en este estudio, Antivipmyn-Tri® fue eficaz y seguro para el tratamiento del envenenamiento bothrópico en Colombia. ABSTRACT: Introduction: Colombia is a country with two whole IgG antivenom producers, but the expectancy of all the market are not fulfilled by different technical reasons. Objectives: To evaluate the efficacy and safety of a F(ab ́)2 polyvalent antivenom produced in Mexico and of a new dosage regimen for Bothrops bites in Colombia. Methods: A clinical trial, including serum venom and antivenom measurements (ELISA), was performed during 9 months in 53 patients. Results: forty four patients were bitten by Bothrops asper in Antioquia and Chocó and 9 by B. atrox in Amazonas; on admission, all of them had nonclottable blood, 30 (56.6%) presented local and24 (45.3%) systemic bleeding. The final envenoming grade was mild in 13 (24.5%), moderate in 30 (56.6%) and severe in 10 patients (18.9%). At the antivenom doses used in this study (5 vials for mild / moderate and 10 for severe envenoming), Antivipmyn Tri® was 100% efficient to decrease significantly serum venom concentrations within the first treatment hour, and to stop local and systemic bleeding within 6-12 hours, 96.2% efficient to restore blood coagulation within 24 hours and 100% within 48 hours. Two patients (3.8%) had recurrence of coagulopathy without bleeding, and there were 12 recurrences of antigenaemia without clinical relevance. Ten (18.9%) patients suffered early mild adverse reactions to fabotherapy. There were no deaths and four patients (7.5%) presented sequelae.