Luis Enrique Bermejo Galan

In Brazil, snakebites are a critical health issue, particularly in the state of Roraima, where Bothrops species account for the majority of cases. Snake venoms contain multifunctional toxins that cause life-threatening systemic complications and complex wounds, often resulting in permanent disabilities. Although antivenoms have reduced lethality, they fail to prevent the rapid and prolonged action of tissue-damaging toxins at the bite site. As a result, snakebite management is characterized by prolonged hospitalizations and high healthcare costs. Therefore, effective management of these complex wounds is crucial to improving patient outcomes. This article presents a series of four clinical cases involving Bothrops snakebite patients treated at the General Hospital of Roraima. Each case describes the progression of the injury, clinical challenges, interventions, and outcomes. Vacuum-Assisted Wound Therapy (VAWT) was employed as a key component of treatment in all cases, promoting faster granulation tissue formation, infection control, and reduced risk of amputation. The use of VAWT demonstrated significant improvements in wound healing compared to conventional treatment approaches. These findings highlight the potential benefits of VAWT in managing complex snakebite-related wounds, especially in severe cases with high risks of complications. However, barriers such as the high cost of therapy and limited access in remote and resource-poor regions must be addressed to enable broader clinical application.

Unlike the well-documented bothropic and crotalid snakebites in Brazil, lachetic envenomings (i.e., triggered by the bushmaster snake) are rare and present significant diagnostic challenges. This case describes a severe envenoming induced by a Lachesis muta snake in a 26-year-old Brazilian man who was bitten near a forest in November 2022. Characteristic symptoms such as sweating and bradycardia pointed towards lachetic envenoming, but initial misdiagnosis as a bothropic bite resulted in a delay in appropriate antivenom therapy. Despite later receiving the correct treatment, the severity of the envenoming necessitated the amputation of a finger and triggered a severe infection. This report highlights the challenges of diagnosing and treating Lachesis spp. bites due to their rarity. Moreover, an overview of lachetic-induced signs and symptoms was explored. This study emphasizes that further reports are warranted to improve understanding of Lachesis muta envenoming and to optimize treatment strategies.

The Brazilian market holds the second position globally in the beauty sector, poised to surpass the USD 50 billion mark in the upcoming years. Aesthetic procedures encompass a spectrum, ranging from non-invasive ones, such as drainage, radiofrequency, ultrasound, and cryolipolysis, to more invasive techniques, including fillers, botulinum toxin, microneedling, micropigmentation, carboxytherapy, and enzyme application. This wide array of treatments has yielded satisfactory cosmetic results for individuals who opt out of surgical procedures. However, despite being categorized as having low complexity, they still carry inherent risks. These risks are often exacerbated by the breach of the skin barrier, the exposure of organs and spaces, or the presence of implantable devices. Among the bacteria most isolated concerning this matter are non-tuberculous Mycobacteria. This study presents descriptive case reports involving three patients under the care of the Infectious Diseases Department at General Hospital of Roraima (HGR). These patients were diagnosed with Mycobacterium abscessus infections subsequent to undergoing enzyme application procedures. Although these cases involve the same microorganism, they exhibit varying degrees of severity, ranging from the development of locally nodular formations to a progression towards sepsis. These cases provide an opportunity to delve into the diagnostic subtleties and clinical implications of these infections while also prompting a critical evaluation of therapeutic strategies. Additionally, the report underscores the potential risks associated with routine aesthetic procedures.

Neurocysticercosis, a parasitic infection of the central nervous system (CNS), is a significant public health issue globally, including in Brazil. This article presents a case report of a 44-year-old male patient residing in the rural area of Roraima, the northernmost region of Brazil within the Amazon Forest. The patient, with chronic HIV infection, acquired the Taenia solium helminth, resulting in neurocysticercosis development. Remarkably, the diagnosis of neurocysticercosis was not initially apparent but emerged through meticulous analysis following a motorcycle accident. The absence of seizures, a common clinical manifestation, complicated the diagnostic process, making it an uncommon case of NCC, which may be related to co-infection. As the patient’s condition progressed, multiple complications arose, requiring additional medical attention and interventions. This case underscores the immense challenges faced by healthcare teams in managing neurocysticercosis effectively. It emphasizes the critical need for a comprehensive, multidisciplinary approach to provide optimal care for such complex cases. The study’s findings underscore the importance of raising awareness and implementing improved strategies for tackling neurocysticercosis, particularly in regions where it remains a prevalent concern.

Objetivo: Estimar a prevalência e os possíveis fatores de risco associados às Infecções Sexualmente Transmissíveis (IST) na terceira idade. Métodos: Trata-se de estudo transversal, analítico de caráter quantitativo, realizado na região norte do Brasil, no período de março a dezembro de 2019, com 200 idosos, os quais foram submetidos a questionários e realização de testes rápidos para Sífilis, Hepatite B, Hepatite C e Vírus da Imunodeficiência Humana (HIV). Resultados: A prevalência das Infecções Sexualmente Transmissíveis (IST) foi de 6% e entre as 12 ocorrências, foram observados 9 casos (4,5%) de sífilis, dois (1%) de hepatite C e um (0,5%) de infecção pelo HIV. Houve associação entre ter IST e ser homem, ter relacionamento fixo e não usar preservativo rotineiramente. Conclusão: Os resultados demonstraram um elevado percentual de ISTs entre idosos associadas a vários fatores, evidenciando situações de vulnerabilidade dessa população. Propõe-se educação contínua por meio dos profissionais de saúde, abordando vários aspectos da sexualidade, formas de prevenção e transmissão das IST, além do diagnóstico precoce, proporcionando assim uma melhor qualidade de vida a essa população.

Objective: Given the urgent need for strategies to minimize the damage caused by this pandemic, this study performed a randomized, double-blind phase 2 study to assess the safety of the effectiveness of chloroquine (CQ), hydroxychloroquine (HCQ) or ivermectin in severe forms of COVID-19, in addition to identifying predictors of mortality in this group of patients. Methods: Phase 2, double-blind, randomized study to assess the safety and efficacy of enteral CQ, HCQ or ivermectin in patients hospitalized for SARS-CoV-2 infection, admitted to a Reference Hospital in Roraima (Brazil) in may 2020. Patients were randomized in a 1:1:1 ratio. The endpoints were need of supplemental O₂, invasive ventilation, admission in ICU and death. The study was approved by an independent IRB. Results: 168 patients were randomized. The mean age was 53.4 years (±15.6), most participants were male (n = 95; 58.2%). Therapy with corticosteroid, anticoagulant or antibiotics was a decision of the attending physicians, and there was no difference between the groups. The mortality was similar in three groups (22.2%; 21.3% and 23.0%) suggesting ineffectiveness of the drugs. No difference in the incidence of serious adverse events were observed. To be older than 60 years of age, obesity, diabetes, extensive pulmonary involvement and low SaO₂ at hospital admission due to independent risk factors for mortality. Conclusion: Although CQ, HCQ or ivermectin revealed a favorable safety profile, the tested drugs do not reduce the need for supplemental oxygen, ICU admission, invasive ventilation or death, in patients hospitalized with a severe form of COVID-19.