Carlos Roberto de Medeiros

(1) Background: The authors developed a new non-invasive dermatological infrared macroimaging analysis technique (MacroIR) that evaluates microvascular, inflammatory, and metabolic changes that may be dermoscopy complimentary, by analyzing different skin and mucosal lesions in a combined way—naked eye, polarized light dermatoscopy (PLD), and MacroIR—and comparing results; (2) Methods: ten cases were evaluated using a smartphone coupled with a dermatoscope and a macro lens integrated far-infrared transducer into specific software to capture and organize high-resolution images in different electromagnetic spectra, and then analyzed by a dermatologist; (3) Results: It was possible to identify and compare structures found in two dermoscopic forms. Visual anatomical changes were correlated with MacroIR and aided skin surface dermatological analysis, presenting studied area microvascular, inflammatory, and metabolic data. All MacroIR images correlated with PLD, naked eye examination, and histopathological findings; (4) Conclusion: MacroIR and clinic dermatologist concordance rates were comparable for all dermatological conditions in this study. MacroIR imaging is a promising method that can improve dermatological diseases diagnosis. The observations are preliminary and require further evaluation in larger studies.

Bites of “nonvenomous” snakes can sometimes be mistaken for the bites of venomous snakes. As an example of this confusion, this report describes confirmed bites by Philodryas olfersii and Bothrops jararaca. In the first case, a 55-y-old man with a history of controlled hypertension was bitten on his right forearm by P olfersii. Physical examination revealed extensive edema, erythema, and widespread ecchymoses throughout his right upper limb. Laboratory tests indicated leukocytosis and high D-dimer levels, but normal coagulation, suggestive of a resolved recent coagulopathy. He received only supportive treatment. In the second case, a healthy 35-y-old man was bitten by B jararaca. Although the anatomic region of the bite and the results of physical examination were similar to those in the first case, laboratory tests showed mild coagulopathy, leukocytosis, and high D-dimer levels. The patient was treated with antivenom. In both cases, the 20-min whole blood clotting test results were normal. Patients bitten by P olfersii may present with local symptoms resembling B jararaca envenomation. Without snake identification and the detection of venom-induced consumption coagulopathy, especially in places where the 20-min whole blood clotting test is the only clotting test available, it is almost impossible to establish an accurate and safe differential diagnosis. In this context, the best alternative is to take the risk of prescribing antivenom for a possible P olfersii bite rather than failing to do so for a real Bothrops bite. Late treatment for Bothrops bite can result in severe complications and sequelae.

A survey in São Paulo, Brazil, assessed travel agents’ knowledge on travellers’ health. Data were collected using an online questionnaire. Of 200 agencies contacted, 32 answered (34 agents). Most consultants reported discussing personal safety, health insurance and vaccination. Few provided information on water and food diseases or sexually transmitted infections.

Keywords: Infrared thermography; Envenomation; Venomous animals

Describes the case of a 6-year-old girl who was stung by a Centruroides testaceus, a scorpion native to the Lesser Antilles, in the Guarulhos International Airport, São Paulo, Brazil, as she disembarked from a flight coming from the Caribbean. The patient presented only local symptoms (a small area of erythema and pain at the sting site), which were resolved after a few hours with analgesics, without the need for antivenom. Physicians who treat patients stung by scorpions should be alert to the possibility of such accidents being caused by non native species, especially those cases that occur near airports or ports.