Acidentes por animais peçonhentos são a segunda causa de envenenamento humano no Brasil, atrás apenas da intoxicação por medicamentos. Nacionalmente os escorpiões são os maiores responsáveis por esse evento, mas existe variação regional conforme os diferentes graus de ocupação humana e hábitat dos animais envolvidos. Este trabalho estudou os acidentes por animais peçonhentos no Estado do Tocantins nos anos de 2010 e 2011, com o objetivo de identificar aspectos clínico-epidemiológicos relacionados a esse agravo. Os dados foram levantados a partir do Sistema de Informação de Agravos de Notificação (SINAN) e relacionados às características pluviométricas da região. Utilizou-se o software BioEstat 5.0® para verificar a validade estatística dos dados através do teste de qui-quadrado, definido um α=5%. Das vítimas, 69,0% eram do sexo masculino e 50,0% tinham idade entre 20 e 49 anos. A maioria dos acidentes ocorreu no período de chuvas e na zona rural (58,9%), ambiente onde os homens foram três vezes mais acometidos que as mulheres. A picada foi mais frequente no pé (40,5%), mão (15,7%) e perna (12,2%), demonstrando que o uso de calçados apropriados, luvas e perneiras pode representar importante medida de proteção. As serpentes causaram a maioria dos acidentes (50,9%), seguidas dos escorpiões (19,7%). Dor e edema foram as principais manifestações clínicas locais relatadas, e infecção secundária a complicação local mais frequente. Dez óbitos foram registrados no período, todos por picada de serpentes. Tais dados mostram que as principais vítimas desses acidentes no Estado são homens jovens procedentes da zona rural, acometidos nas extremidades corporais, especialmente no período de chuvas. Palavras-chave: envenenamento; picada; epidemiologia. ABSTRACT Accidents by venomous animals are the second cause of human poisoning in Brazil, second only to drug intoxication. Nationally the scorpions are most responsible for this event, but there is regional variation according to different degrees of human occupation and habitat of the animals involved. This study examined the envenomations in Tocantins State in the years 2010 and 2011, with the aim of identifying clinical and epidemiological aspects related to this condition. The data were collected from the Notifiable Diseases Information System (SINAN) and related to rainfall characteristics of the region. It was used the BioEstat 5.0® software to check the statistical validity of the data by the chi-square test, defined an α = 5%. Of all the victims, 69.0% were male and 50.0% were aged between 20 and 49 years. Most accidents occurred during the rainy season and in the countryside (58.9%), environment where men were three times more affected than women. The bite was most frequent in the foot (40.5%), hand (15.7%) and leg (12.2%), demonstrating that the use of proper footwear, gloves and leggings may represent important protective measure. Snakes caused the most injuries (50.9%), followed by scorpions (19.7%). Pain and swelling were the main local clinical manifestations reported, and secondary infection the most frequent local complication. Ten deaths were recorded in the period, all by the bite of serpents. These data show that the main victims of such accidents in the State are young men coming from rural areas, hit in the body’s extremities, especially during the rainy season. Keywords: poisoning; bite; epidemiology

Objective:Traumatic spinal cord injury is one of the leading causes of disability worldwide, mainly related to automobile accidents. It was decided to establish a clinical-epidemiological profile of spinal cord injury (SCI) in Palmas, Brazil.Method:Prospective study at the Public General Hospital of Palmas (HGPP), including all patients admitted in this hospital from January 2011 to February 2012.Results:They refer to 59 patients, of whom 81.4% were men and 47.4% of the victims had up to 40 years. The main mechanism of injury was motor vehicle accidents involving motorcycles. Clinically, the vertebral segment C4-C7 was the most damaged, and most patients were admitted with spinal injury and no neurological deficit (Frankel E).Conclusions:Primary involvement of young men in working age, trauma mainly due to car accidents that are usually associated with the use of alcoholic beverages. Patients admitted with more severe neurological deficits have evolved to milder impairments after conservative or surgical treatment.

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BACKGROUNDCalcium pyrophosphate deposition (CPPD) disease is an arthropathy caused by calcium pyrophosphate dihydrate (CPP) crystal deposits in articular tissues, most commonly fibrocartilage and hyaline cartilage. Calcium pyrophosphate deposition of the atlanto-occipital joint, also known as CDS, can cause periodic acute cervico-occipital pain with fever, neck stiffness and laboratory inflammatory evidences. The true incidence and prevalence of CDS in the general population or in those with CPPD remain unknown. We report two cases of CDS clinically characterized by asymptomatic CDS (case 1) and cervical spine myelopathy (case 2). CASE REPORTCase 1: B.S.S., 79-year-old female, presented knee pain and bilateral functional limitation associated with acute synovitis in the right knee. Laboratory results revealed hypomagnesemia and elevated inflammatory markers. Plain radiograph of the knees demonstrated CPPD-associated osteoarthritis. Chondrocalcinosis (CC) was also evidenced at other sites, such as wrists and symphysis pubis. Cervical spine CT showed atlantodental osteoarthrosis and the presence of calcifications near the anteroposterior tubercle of the atlas, compatible with asymptomatic CSD. Colchicine and magnesium replacement were started as a treatment option. Case 2: J.F.A., 80-year-old male, had neck pain with stiffness, weakness on the right side of the body with hyperactive and symmetrical deep reflexes, except for the Achilles reflex, which were abolished, and urinary incontinence, which worsened progressively. No history of cervical trauma. Cervical spine CT demonstrated periodontal calcifications, C1-C2 subluxation, and cervical canal stenosis. Surprisingly, physical examination revealed knees joints inflammation and radiograph findings were consistent with CC. Patient was diagnosed with cervical myelopathy secondary to CDS and DPPC and clinically treated with colchicine and corticosteroid. Moreover, surgical removal of the posterior arch of C1 and enlargement of the foramen magnum with occipitocervical fixation was performed. CONCLUSIONThe CSD is defined as clinical presentation of episodic cervical pain and neck stiffness with associated radiological findings of calcifications surrounding the odontoid process. We described a symptomatic case with signs of cervical myelopathy, and an asymptomatic CDS, diagnosed during screening imaging studies for CC. Crowned dens syndrome is rarely considered as a diagnosis in part due to lack of awareness among clinicians. Recent studies suggest wide variation in the prevalence of CSD, ranging from 51 to 69%. Cervical spine CT should be considered in elderly patients with neck pain, in particular when there is evidence of CPPD or CC in other joints. Moreover, other conditions such as polymyalgia rheumatica, giant cell arteritis or meningitis should be ruled out.

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