In the Brazilian Amazon, long distances, low healthcare coverage, common use of ineffective or deleterious self-care practices, and resistance to seeking medical assistance have an impact on access to antivenom treatment. This study aimed to estimate snakebite underreporting, and analyze barriers that prevent victims from obtaining healthcare in communities located in 15 municipalities on the banks of the Solimões, Juruá and Purus Rivers, in the remote Western Brazilian Amazon. Information on the participants’ demographics, previous snakebites, access to healthcare, time taken to reach medical assistance, use of self-care practices, and the reason for not accessing healthcare were collected through semi-structured interviews. In the case of deaths, information was collected by interviewing parents, relatives or acquaintances. A total of 172 participants who reported having suffered snakebites during their lifetime were interviewed. A total of 73 different treatment procedures was reported by 65.1% of the participants. Participants living in different river basins share few self-care procedures that use traditional medicine, and 91 (52.9%) participants reported that they had access to healthcare. Living in communities along the Juruá River [OR = 12.6 (95% CI = 3.2–49.7; p<0.001)] and the use of traditional medicine [OR = 11.6 (95% CI = 3.4–39.8; p<0.001)] were variables that were independently associated to the lack of access to healthcare. The main reasons for not accessing healthcare were the pprioritization of traditional treatments (70.4%), and the failure to recognize the situation as being potentially severe (50.6%). Four deaths from complications arising from the snakebite were reported, and three of these were from communities on the banks of the Juruá River. Only one of these received medical assistance. We found an unexpectedly high underreporting of snakebite cases and associated deaths. Snakebite victims utilized three main different healing systems: 1) self-care using miscellaneous techniques; 2) official medical healthcare generally combined with traditional practices; and 3) self-care using traditional practices combined with Western medicines. To mitigate snakebite burden in the Brazilian Amazon, an innovative intervention that would optimize timely delivery of care, including antivenom distribution among existing community healthcare centers, is needed.

Snakebite envenoming (SBE) is a neglected tropical disease with significant global morbidity and mortality. Even when antivenom is available in low-resource areas, health workers do not receive adequate training to manage SBEs. This study aims to develop and validate a clinical practice guideline (CPG) for SBE management across Brazil. A panel of expert judges with academic and/or technical expertise in SBE management performed content validation. The content validity index (CVI) score was 90% for CPG objectives, 89% for structure and presentation and 92% for relevance and classified the CPG as valid. A semantic validation was performed by analyzing focus group discussions with doctors and nurses from three municipalities of the Brazilian Amazon, after a 5-day meeting during which the CPG was presented. Two central themes emerged: knowledge acquired during the meeting and recommendations for improving the CPG. Based on these results, the CPG was revised into a final version. This study presents the successful development and validation process of a CPG for SBE management, which is targeted to a specific low-resource, high-burden setting. This development and validation process can be adapted to other settings and/or other neglected tropical diseases.

Snakebites are a neglected and underestimated global health hazard. In the Brazilian Amazon, Bothrops snakebites are the most prevalent and may lead to severe complications. Here we describe a severe case of Bothrops atrox snakebite that, owing to delayed medical assistance, presented with renal and respiratory failure, compartment syndrome, and tissue necrosis. After several fasciotomy surgeries, the patient survived; however, he showed significant functional disability. Prompt management of snake envenomation would aid in the early diagnosis of local and systemic complications and, consequently, would result in a better functional outcome with improved quality of life.

Zika virus (ZIKV) is transmitted to humans by the infectious bite of mosquitoes such as Aedes aegypti. In a city, the population control of mosquitoes is carried out according to alerts generated by different districts via the analysis of the mosquito index. However, we do not know whether, besides mosquito abundance, the susceptibility of mosquitoes could also diverge among districts and thus impact the dissemination and transmission of arboviruses. After a viremic blood meal, the virus must infect the midgut, disseminate to tissues, and reach the salivary gland to be transmitted to a vertebrate host. This study evaluated the patterns of ZIKV infection in the Ae. aegypti field populations of a city. The disseminated infection rate, viral transmission rate, and transmission efficiency were measured using quantitative PCR at 14 days post-infection. The results showed that all Ae. aegypti populations had individuals susceptible to ZIKV infection and able to transmit the virus. The infection parameters showed that the geographical area of origin of the Ae. aegypti influences its vector competence for ZIKV transmission.

Background: Smartwatches have gained popularity for their potential to provide accurate measurements of various physiological parameters. However, the validity of energy expenditure (EE) across different smartwatch models remains a topic of ongoing investigation. Discrepancies between results obtained from different models and gold standard methods are particularly critical across varying exercise intensities and types, as validation studies have demonstrated overestimation when wearable activity monitors are compared with indirect calorimetry. Objective: This study investigated the accuracy of 2 versions of the Samsung smartwatch (Galaxy Watch [GW] 6 and 7) in measuring EE during intermittent moderate-intensity running exercises, using indirect calorimetry as the gold standard method. Methods: This study included 148 healthy adults, comprising 80 men and 68 women. Participants performed intermittent treadmill running, consisting of walking at 5 km·h⁻¹ for 1 minute and running between 8 and 16 km·h⁻¹ for 2 minutes, based on participant preference, for a total duration of 27 minutes. The GW6 and GW7 models were used and EE was measured by indirect calorimetry using a wearable portable metabolic gas analysis system (K5; Cosmed), which is considered a gold standard method. Results: No statistically significant differences were found between the GW models and the K5. The K5 showed a mean EE of 213.60 (SD 43.04) kilocalories, compared with 219.53 (SD 35.70) kilocalories for the GW6 and 202.67 (SD 47.42) kilocalories for the GW7 (all P >.05). Good Spearman correlations (0.63‐0.70) and moderate intraclass correlation coefficients (0.65‐0.74) were found. Mean absolute percentage error values ranged from 10.10% to 12.55%. Bland-Altman analysis revealed limits of agreement for all comparisons (K5 vs GW6 and GW7, −61.93 to 65.80 kcal). Conclusions: The GW6 and GW7 devices showed moderate validity for estimating EE during intermittent running exercises, demonstrating the suitability of the GW as a low-cost and practical wearable option for daily physical activities.

Despite significant and successful efforts in Brazil regarding snakebites in the areas of research, antivenom manufacture and quality control, training of health professionals in the diagnosis and clinical management of bites, little is known about determinants of snakebites incidence in order to further plan interventions to reduce the impact of this medical condition. Understanding the complexity of ecological interactions in a geographical region is important for prediction, prevention and control measures of snakebites. The aim of this investigation is to describe spatial distribution and identify environmental determinants of human- lancehead pit vipers ( Bothrops genus) contact resulting in injuries, in the Brazilian Amazon. Aggregated data by municipality was used to analyze the spatial distribution of Bothrops bites cases and its relationship with geographic and environmental factors. Eight geo-environmental factors were included in the analysis as independent variables: (1) tree canopy loss increase; (2) area with vegetation cover; (3) area covered by water bodies; (4) altitude; (5) precipitation; (6) air relative humidity; (7) soil moisture; and (8) air temperature. Human- lancehead pit vipers ( Bothrops genus) contact resulting in envenomings in the Amazon region is more incident in lowlands [-0.0006827 (IC95%: −0.0007705; - 0.0005949), p<0.0001], with high preserved original vegetation cover [0.0065439 (IC95%: 0.0070757; 0.0060121), p<0.0001], with heaviest rainfall [0.0000976 (IC95%: 0.0000925; 0.0001026), p<0.0001] and higher air relative humidity [- 0.0081773 (IC95%: −0.0107681; −0.0055865), p<0.0001]. This association is interpreted as the result of the higher forest productivity and abundance of pit vipers in such landscapes. Author summary: Despite successful efforts in Brazil regarding snakebites in the areas of research, antivenom manufacture and quality control and training of health professionals, little is known about determinants of snakebites incidence in order to further plan interventions to reduce the impact of this medical condition. Understanding the complexity of ecological interactions in a geographical region is important for prediction, prevention and control measures of snakebites. The aim of this study is to describe spatial distribution and identify environmental determinants of human- lancehead pit vipers ( Bothrops genus) contact resulting in injuries, in the Brazilian Amazon. An increase in the forest productivity with a higher availability of some types of prey, such as frogs and amphibians, anurans and lizards, was suggested as a cause for the higher snake abundance in the rainy season. Probably due to the higher forest productivity and abundance of pit vipers in such landscapes, human-lancehead pit vipers contact resulting in envenomings in the Amazon region is more incident in lowlands, with high preserved original vegetation cover, with heaviest rainfall and higher air relative humidity.