This reports a case of scorpionism caused by Tityus serrulatus. A male adult was stung while unloading bananas at the supply center in Belém, Pará, Brazil. The bananas originated in another state (Bahia) and were brought to Belém by truck. The patient presented with pain, edema, and erythema at the sting site, and was classified as low-risk. The specimen was identified as T. serrulatus and symptomatic treatment and clinical observation were advised. The patient was discharged later without further complications. This is the first known envenomation caused by T. serrulatus, a non-native species to Pará, in the Brazilian Amazon.

This research aims to determine whether the combination of epidemiological and clinical features can predict malaria. Diagnostic investigation detected 22.3% of individuals with Plasmodium vivax (P. vivax) malaria, with significant predominance of the male gender. The malaria triad (fever, chills and headache) had a more expressive frequency (81.1%) in individuals with positive thick blood than those with negative thick blood smear (65.1%), although there was no statistical significance. Among the variables analysed as predictive for positive thick blood smear, it was observed that personal history of travel to an endemic malaria area and past malaria infection (PMI) were significantly associated with malaria, even in multiple logistic regression. Fever had the higher sensitivity (94.6%) and past malaria history had the greater specificity (68.2%), with accuracy of 23.5% and 67.5%, respectively. In combined analysis, fever with chills had the highest sensitivity (91.9%), but low accuracy (38.5%). High specificity (91.5%) was found in the association of malaria triad, PMI and history of travel to endemic malaria area (which along with anorexia, was higher 94.6%), with good accuracy (80.7%), suggesting that the screening of patients for performing thick blood smear can be based on these data. The epidemiological features and the malaria triad (fever, chills and headache) can be predictors for identification of malaria patients, concurring to precocious diagnosis and immediate treatment of individuals with malaria.

Objective To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability. Methods This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará . One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine. Results Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days). There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death. Conclusion The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.

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Analisar as intoxicações por ciproeptadina, no período de 2007 a 2015, em crianças de 1 a 12 anos de idade, registradas no banco de dados do Centro de Informações Toxicológicas de Belém, estado do Pará, Brasil. MATERIAIS E MÉTODOS: Estudo descritivo e retrospectivo dos casos de intoxicação em crianças, oriundos do Centro de Informações Toxicológicas de Belém. Foram consideradas todas as intoxicações com formulações contendo a ciproeptadina associada a vitaminas, registradas de 2007 a 2015, ponderando as variáveis: sexo, idade, mês, anos, zona, tempo decorrido da exposição, sinais, sintomas e evolução dos casos. Foram utilizados os softwares Epi Info TM v6.6 e Microsoft Excel Starter 2010 para a análise dos dados. RESULTADOS: Dos 1.719 casos de intoxicações por medicamentos, 60 (3,5%) foram causados pela ciproeptadina na faixa etária do estudo. O sexo masculino foi o mais acometido (75,0%), na faixa etária de 1 a 4 anos (80,0%). Os casos aconteceram majoritariamente na zona urbana (96,7%), com o tempo entre o acidente e o atendimento de 1 a 5 h (38,3%). Os sintomas mais frequentes foram agitação, sonolência e confusão mental. CONCLUSÃO: As circunstâncias dos casos foram principalmente por ingestão acidental de quantidade acima da recomendada, que evoluíram, em sua maioria, para a cura. Estes dados servem para alertar os profissionais de saúde sobre o uso de estimulantes de apetite, tal como a ciproeptadina.