The role of social media in public health awareness during times of war in Sudan: snakebites and scorpion stings.

BACKGROUND: Snakebite envenomation (SBE) and scorpion sting envenomation (SSE) are significant neglected tropical diseases that primarily affect impoverished communities in rural areas of developing nations. A lack of understanding about snake and scorpion species and their distribution exacerbates the disabilities and fatalities caused by SBE and SSE. In Sudan, particularly in regions affected by ongoing conflicts where healthcare resources are scarce, social media platforms offer a cost-effective approach to addressing public health challenges. Our aim in this study is to highlight the benefits of using social media for data collection and health promotion in such environments. METHODS: We present a cost-effective communication and data collection strategy implemented at the Toxic Organisms Research Centre (TORC) of the University of Khartoum, focusing on a Facebook group, "Scorpions and Snakes of Sudan", as our primary social media platform. Additionally, we discuss the lessons learned and the initial impact of this strategy on enhancing population health literacy. RESULTS: The group community is composed of ~ 5000 members from 14 countries. During the period from January 2023 to January 2024, we received 417 enquiries about snakes and scorpions belonging to 11 families and composed of 55 species. In addition, 53 other enquiries covered a range of organisms and their tracks (e.g., spiders, skinks, chameleons, foxes, sun spiders, centipedes, lizards, moth larvae, and insect tracks). The first photographic evidence of Malpolon monspessulanus in Sudan was via the group activities. The rare species Telescopus gezirae, the Blue Nile cat snake, is also documented via the group member's queries. Recognizing the evolving nature of social media use in public health, we also address the current limitations and evidence gaps that need to be addressed to effectively translate best practices into policy. CONCLUSION: In conclusion, utilizing Facebook as an institutional platform to share scientific information in simple Arabic language underscores the proactive roles that citizens, scientists, and public health stakeholders can play in leveraging social media for eHealth, eAwareness, and public health initiatives. This approach highlights the potential for collaborative efforts, particularly during crises, to maximize the benefits of social media in advancing public health.

Evaluation of Scorpion Stings in Children.

INTRODUCTION: Scorpion stings are a significant public health problem in many parts of the world. Children are at a higher risk of developing severe complications from scorpion envenoming, including cardiac, respiratory, and neurologic complications. In Turkey, members of the Buthidae family are the most common culprits in severe envenoming events. METHODS: This retrospective-descriptive study was conducted in Turkey. Children aged 0 to 18 y admitted to the emergency department of Kahta State Hospital between December 2017 and December 2020 were included in the study. Patient information was reviewed, and 78 patients with complete demographic, laboratory, and clinical data were included in the study. RESULTS: Out of the 78 patients, 24.4% were six years old or younger while the 75.6% were older than six years. Alpha blocker was given to 12.8% of the patients, and antivenom was given to 43.6% of the patients. Of the 78 patients, 71.8% were followed up in the emergency department, 21.8% were followed up in the inpatient unit, and 6.4% were followed up in the intensive care unit. Two patients (2.6%) died within 1 month. There was a significant difference regarding lactate dehydrogenase value according to the sting site (P=0.014). Lactate dehydrogenase values of patients stung on the head and neck and upper extremity were higher than those of patients bitten on lower extremities. CONCLUSIONS: Elevated levels of specific laboratory parameters, such as leukocytes, aspartate transaminase, and lactate dehydrogenase, are linked to worse outcomes. Additionally, stings on the head, neck, and upper extremities are more strongly associated with severity. These findings guide tailored treatment strategies for scorpion stings, with the potential for further refinement through broader studies across diverse regions and populations.

Scorpion Stings in Minas Gerais (Brazil): A Monocentric Retrospective Study Evaluating All Envenoming Cases of Local Scorpionism.

INTRODUCTION: We aim to provide better insights into the demographic, epidemiological, and seasonal characteristics of scorpion envenomation reported in the Rio Doce Valley, Brazil. METHODS: We conducted this monocentric retrospective descriptive study with data on Investigation Forms of Accidents by Venomous Animals, only envenoming cases of scorpion stings, between January 1, 2017 and December 31, 2020, belonging to the compulsory notification system of the Municipal Hospital of Governador Valadares. RESULTS: There were 3032 accidents, and the male-to-female ratio was 1.17:1 (male, 54%; females, 46%). Accidents occurred every month, but there was an increase in June, July, and October to January. In most cases, the time between the scorpion sting and medical care was between 1 and 3 h (n=1304; 43%). The most frequent clinical and systemic manifestations were pain at the bite site (94%) and vagal symptoms (7%). Cases were mild (n=2750, 91%), moderate (n=221, 7%), and severe (n=56, 2%). Children younger than 10 y constituted the most cases, 522 (17%). There was a significant difference between clinical severity and age (P<0.01). Ten patients developed acute pulmonary edema. Two 4-y-old children died. All severely envenomated patients as well as 74% and 2% of mild and moderately envenomated patients, respectively, received specific scorpion antivenoms. CONCLUSIONS: Scorpion envenomation is of greater severity in children aged <10 y. The clinical presentation includes mainly local pain associated with vagal symptoms. Accidents occur every month, but there was an increase in June, July, and October to January.

Clinical features and prognosis of severe scorpion envenomation in children.

BACKGROUND: Scorpionism is endemic and represents a real public health problem in Morocco. The most dangerous arthropod in the central area is Androctonus mauretanicus (Am) scorpion. Its venom can be lethal, especially for children. This study aimed to determine a clinico-epidemiological profile of severe scorpion envenomation among children and identify risk factors for mortality. METHODS: This retrospective cohort study included 606 children admitted for severe scorpion envenomation (SSE) from January 2010 to July 2015 in the Pediatric Intensive Care Unit (PICU) of Mohammed VI Teaching Hospital. RESULTS: The mean age of envenomed children was 6.3 ± 4.2 years. Seventy-four percent of them came from rural settings. Envenomation occurred mostly during the summer months and 78.4% of stings were nocturnal. The time between the sting and evaluation was greater than 2 h in 83% of cases. Bivariate analysis indicated that from 1 to 24 months of age (P = 0.001), hyperthermia (P = 0.022), episodes of diarrhea (P < 0.001), tachycardia (P < 0.001), abdominal distention (P < 0.001), skin marbling (P < 0.001), signs of respiratory distress (P < 0.001), irritability (P < 0.001), generalized seizures (P = 0.053), and Glasgow Coma Score (GCS) of 3 to 9 (P < 0.001) were significantly correlated with mortality. On multivariate analysis, diarrhea (P = 0.007), skin marbling (P = 0.006), and respiratory distress (P = 0.002), and GCS 3-9 (P = 0.007) were found to be independent risk factors for mortality in our patient population. CONCLUSIONS: Children are at high risk of developing serious complications, even death, from severe scorpion envenomation. Here we identified multiple factors that appear to increase the mortality risk in children after scorpion envenomation, including previously described central nervous system alterations.

The Role of ProBNP on Prognosis in Scorpion Stings.

INTRODUCTION: Scorpion stings are a major health problem with potentially fatal consequences. Children under the age of 10 y especially face a great risk. Predicting the prognosis is important in reducing mortality and morbidity because it enables the use of early treatment options. In this study, we examine the relationship between proBNP and prognosis in scorpion stings. METHODS: This is a retrospective analysis of patients aged ≤18 y who were admitted to the child emergency service with a scorpion sting. We examined the demographical data, clinical findings, laboratory records, treatments, and results of the patients. We classified stage 1 and stage 2 scorpion envenomation as group 1 (mild-moderate) and stage 3 and 4 as group 2 (severe). A t test was used for normally distributed data, and the Mann-Whitney U test was used for nonnormally distributed data. The correlation analysis was done using the Spearman test. RESULTS: There were 32 (74%) patients in the mild-moderate group and 11 (26%) in the severe group. ProBNP 1 was significantly higher in the severe group at admission (P=0.016). There was no difference between the troponin I values (P=0.051). ProBNP 2 (12th hour) and proBNP 3 (24th hour) were higher in the severe group (P=0.001 and P=0.032, respectively). There was a negative correlation between proBNP and echocardiographic findings involving ejection fraction and shortening fraction (r=-0.703, P=0.002). CONCLUSIONS: In our study, the first proBNP values were significantly higher in the severe group. This suggests that proBNP may be beneficial in predicting prognosis.

A Relationship Between Clinical and Laboratory Characteristics in Children With Severe Scorpion Envenomation in Çukurova, Turkey.

OBJECTIVE: Scorpion stings are an important health problem in many parts of the world. The aim of this study was to retrospectively examine cases of scorpion stings to evaluate their epidemiological, clinical, and laboratory features and to determine strategies that can reduce morbidity and mortality in these cases. METHODS: Scorpion stings experienced by children between 2007 and 2013 were retrospectively reviewed. The patients were categorized into groups based on severities of toxicities, and demographic, clinical, and laboratory features were compared between the groups. RESULTS: The mean ± SD age of the 189 patients with scorpion stings was 83.43 ± 59.62 months. There was a significant difference between the clinical stages and the age distribution of the cases (P < 0.05). White blood cell counts differed significantly between the groups (P < 0.05). There was not a significant difference in mean platelet volume and platelet distribution width between the groups, but plateletcrit and low platelet count were significantly different between stage 1 and stage 3 cases (P < 0.05). Glucose, creatinine kinase-myoglobin binding, and troponin I were also significantly different (P < 0.05). The mortality rate was 0%. CONCLUSIONS: People living in regions where scorpion stings are frequent should be informed about preventive measures against these stings, cases of scorpion stings should be monitored in appropriate centers, and staff offering care to these cases should be educated about treatment methods. In addition, treatment protocols should be determined in accordance with regions where the stings occur and studies should be performed to describe prognostic indicators.

Review of Scorpion Stings and Snakebites Treated by the French Military Health Service During Overseas Operations Between 2015 and 2017.

INTRODUCTION: Depending on their theatre of operation, French soldiers may potentially be exposed to scorpion stings and snakebites. Following the recommendations of a French military health service (FMHS) technical committee for envenomation, the FMHS provides antivenoms appropriate to each deployment. This work aimed to evaluate this risk of envenomation and to assess the antivenoms used by the FMHS in operational theatres since the creation of this committee in 2015. METHODS: Cases were identified based on a review of temporary authorization of use application forms for the use of antivenom. Data were collected retrospectively from these forms, and prescribing physicians were contacted for any missing data. RESULTS: Between 2015 and 2017, 28 requests for temporary authorization of use were identified: 19 for Scorpifav (Sanofi-Pasteur, Lyon, France) and 9 for Fav-Afrique (Sanofi-Pasteur). The FMHS treated 15 soldiers and 4 civilians for scorpion envenomation with Scorpifav: 15 in Mali, 3 in Chad, and 1 in Niger. Systemic signs were observed in 7 patients. Two soldiers and 7 civilians were treated with Fav-Afrique for ophidian envenomation: 5 in Djibouti, 3 in Mali, and 1 in the Republic of Côte d'Ivoire. These 28 patients were treated without sequelae. Other than moderate erythema that resolved with an antihistamine, no adverse effects were reported. Medical evacuation to France was unnecessary. CONCLUSIONS: This study shows that the risk of envenomation for soldiers on deployment is low but real. Antivenoms used by the FMHS were efficient and well tolerated, preserving the operational capacity of deployed troops.

Preparation of F(ab')2 antivenom in Iraq against scorpion (Hottentotta saulcyi) venom.

The aim of this study was to prepare specific F(ab')2 antivenom against Iraqi scorpion (Hottentotta saulcyi). Venom was obtained by electrical stimulation method, the scorpions venom storage capacity was 1.7 ±â€¯0.4 mg and LD50 found to be 1.07 mg/kg by subcutaneous (s.c) route. Three local horses aging 3-4 years were selected for immunization. During the schedule each horse received 0.5-14 mg venom in 49 days by s.c route. The horses immune response was monitored by Ouchterlony double immunodiffusion method, however, older horse A showed the highest antibody titer (1:1056576). Hyperimmune plasma was purified by modified World Health Organization (WHO) protocol using pepsin and ammonium sulfate, whereas high purity and total removal of albumin was detected by serum protein electrophoresis (SPEP) method on cellulose acetate. ED50 of the antivenom was determined via s.c route and found to be 83 LD50/ml, neutralizing 1.78 mg (venom)/ml (antivenom). Protein concentration of the antivenom was 30 mg/ml, less than limited value (100 mg/ml) by WHO. Abnormal toxicity test showed no abnormal signs when 0.2 ml of the antivenom injected intraperitoneally in mice.

Scorpion Envenomation in Pregnancy.

Scorpion envenomation affects more than 1 million people every year and represents an important public health problem worldwide. The effects of envenomation range from localized pain and paresthesias to overactivation of the sympathetic nervous system, leading to neurotoxicity and even death. Of the individuals affected by scorpion envenomation, certain populations, such as young children and older adults, are at high risk for severe disease. Substantial literature exists on the management of envenomation in children; however, scant literature exists that addresses the same phenomenon in pregnant women. This review serves to identify the effects of scorpion envenomation on pregnant women and the treatment options available to them. After thorough review of the treatment modalities that are used to treat scorpion envenomation, we developed a treatment algorithm that may help guide the management of pregnant women who present with scorpion envenomation.

Clinical and Epidemiological Aspects of Scorpionism in the World: A Systematic Review.

OBJECTIVE: Scorpion stings are registered worldwide, but the incidence and the features of the envenomations vary depending on the region. The aim of this review was to summarize the epidemiological, clinical, diagnostic, and therapeutic data worldwide regarding humans stung by scorpions. METHODS: A systematic review of the literature was conducted through the online databases of the Virtual Health Library (VHL), which hosts Medline and the Latin American and Caribbean Center on Health Sciences Informational (LILACS) database. We selected articles published between January 1, 2002 and July 31, 2014. RESULTS: Scorpion envenomation reports were found throughout the world, mainly in subtropical and tropical regions. The clinical manifestations were sympathetically and parasympathetically mediated, depending on the species of scorpion. Some of the most common severe complications of scorpionism included respiratory distress syndrome, pulmonary edema, cardiac dysfunction, impaired hemostasis, pancreatitis, and multiple organ failure. Scorpion envenomation could be classified as mild, moderate, and severe, and the therapeutic approach was based on the case severity. The treatment comprised 3 components: symptomatic measures, vital functions support, and injection of antivenom. Moreover, the time that elapsed between the sting and administration of the appropriate medical care was extremely important to the patient's prognosis. CONCLUSIONS: The large number of scorpion stings worldwide is concerning and reaffirms the need for new prevention measures and policies to reduce the incidence, prevalence, morbidity, and mortality rates from these poisonous arachnids.

A camelid antibody candidate for development of a therapeutic agent against Hemiscorpius lepturus envenomation.

Hemiscorpius lepturus scorpionism poses one of the most dangerous health problems in many parts of the world. The common therapy consists of using antivenom antibody fragments derived from a polyclonal immune response raised in horses. However, this immunotherapy creates serious side effects, including anaphylactic shock sometimes even leading to death. Thus, many efforts have been made to introduce new replacement therapeutics that cause less adverse reactions. One of the most attractive approaches to replacing the available therapy is offered by single-domain antibody fragments, or nanobodies (Nbs). We immunized dromedaries with H. lepturus toxin and identified a functional recombinant Nb (referred to as F7Nb) against heminecrolysin (HNc), the major known hemolytic and dermonecrotic fraction of H. lepturus venom. This Nb was retrieved from the immune library by phage display selection. The in vitro neutralization tests indicated that 17.5 nmol of the F7Nb can inhibit 45% of the hemolytic activity of 1 EC100 (7.5 µg/ml) of HNc. The in vivo neutralization tests demonstrated that F7Nb had good antihemolytic and antidermonecrotic effects against HNc in all tested mice. Surprisingly, F7Nb (8.75 nmol) neutralized 1 LD100 of HNc (10 µg) via an intracerebroventricular route or 1 LD100 (80 µg) via a subcutaneous route. All of the control mice died. Hence, this Nb is a potential leading novel candidate for treating H. lepturus scorpionism in the near future.

Fatal scorpion sting in a child.

Fatal scorpion stings are rare in Nigeria. Hitherto, there has been no report from Nigeria of death following scorpion stings. This report is that of a 2-year-old boy who was stung by a scorpion while playing outside his home environment in Osogbo, South West Nigeria. He subsequently presented to the Children Emergency Unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, in pain and with features of shock. He died within 2 h of admission despite all treatment given to relieve pain and manage shock. The case is reported in order to share the important lessons learned.

Development and Efficacy of the Antivenom Specific to Severe Envenomations in Morocco and North Africa: Advancements in Scorpion Envenomation Management.

Scorpion envenomation poses a global public health issue, with an estimated 1,500,000 cases worldwide annually resulting in 2600 deaths. North Africa, particularly Morocco, experiences severe envenomations, mainly attributed to Androctonus mauretanicus and Buthus occitanus in Morocco, and Buthus occitanus and Androctonus australis hector in Algeria and Tunisia, with case numbers often underestimated. Current treatment relies mainly on symptomatic approaches, except in Morocco, where management is limited to symptomatic treatment due to controversies regarding specific treatment. In Morocco, between 30,000 and 50,000 scorpion envenomation cases are reported annually, leading to hundreds of deaths, mainly among children. Controversies among clinicians persist regarding the appropriate course of action, often limiting treatments to symptomatic measures. The absence of a specific antivenom for the venoms of the most lethal scorpions further exacerbates the situation. This study aims to address this gap by developing a monovalent antivenom against the endemic and most dangerous scorpion, Androctonus mauretanicus. The antivenom was produced by immunizing albino rabbits with a mixture of Androctonus mauretanicus venom collected from high-risk areas in Morocco. Immunizations were performed by subcutaneous injections at multiple sites near the lymphatic system, following an immunization schedule. Production control of neutralizing antibody titers was conducted through immunodiffusion. Once a sufficient antibody titer was achieved, blood collection was performed, and the recovered plasma underwent affinity chromatography. The efficacy of purified IgG was evaluated by determining the ED50 in mice, complemented by histological and immunohistochemical studies on its ability to neutralize venom-induced tissue alterations and the neutralization of toxins bound to receptors in the studied organs. The monovalent antivenom demonstrated specificity against Androctonus mauretanicus venom and effective cross-protection against the venom of the scorpions Buthus occitanus and Androctonus australis hector, highly implicated in lethal envenomations in the Maghreb. This study shows that the developed monovalent antivenom exhibits notable efficacy against local scorpions and a surprising ability to neutralize the most lethal envenomations in North Africa. These results pave the way for a new, more specific, and promising therapeutic approach to countering severe scorpion envenomations, especially in Morocco, where specific treatment is lacking.

Scorpion sting in Hafizabad, Pakistan: Facility based epidemiological study.

Scorpion envenomation is a widespread issue in tropical and subtropical countries. In the present study epidemiology of scorpion sting cases and potential treatment options in district Hafizabad, Pakistan are documented. Hafizabad city and the adjacent villages were selected for the data collection. Age, gender, time, site of scorpion sting on the body, scorpion sting symptoms, number of patients obtaining medical attention and the number of fatalities (if any) were noted. Data showed that scorpion envenomation often occurs in people between the ages of 16-47 years. There were more female victims (55%) and most of the scorpion sting incidences (55.49%) occurred between 07 PM and 02 AM Among body parts, both the hands (41.71%) and feet (48.57%) were more vulnerable to scorpion stings. In rural areas, the incidences of scorpion stings were higher (68.57%). The reported symptoms of scorpion stings include pain, hypertension, nausea and allergy. Out of all the victims, only 56.05% sought treatment from health care units as well as traditional medicine practitioners. However, others (43.94%) fully healed on their own without any treatment. People were using different types of plant-based materials and dead scorpions with mustard oil as a potent remedy against scorpion stings. Moreover, in the health care units there was no antivenom available and medical staff usually used common pain killers such as Xylocain and Lignocain for the treatment of scorpion sting.

Managing scorpion envenomations: A Gabes emergency department case study of 60 patients.

INTRODUCTION: Scorpion envenomation constitutes a major public health issue in Tunisia, especially in arid regions such as the Gulf of Gabes. It is necessary to understand the epidemiological and clinical characteristics of this condition and the importance of early management. AIM: This study aims to assess the epidemiological and clinical profile of patients admitted to the emergency department of Gabes University Hospital for scorpion envenomation, as well as the timing of management and intra-hospital evolution. METHODS: A retrospective descriptive study of 60 patients admitted for scorpion envenomation to the Acute Assessement unit at the Emergency Department of the Gabes University Hospital from January 2020 to January 2023. RESULTS: The average age was 35 years [1-85 years]. A slight male predominance (51.7%) was noted. Patients with chronic somatic diseases accounted for (25%) of our series. The predominant scorpion species was Androctonus australis (71.7%). The majority of incidents occurred during the nighttime (71.7%). Most patients were of rural origin (58.3%). The most common sting sites were the lower limbs (48.8%) and upper limbs (36.7%). Scorpion envenomation stages at admission were: Stage I (3.3%), Stage II (83.3%), and Stage III (8.33%). The average time to management was 2 hours. Patients classified as Stage II at admission or afterward were seen after an average of 3 hours. Patients initially classified as Stage III were seen after an average of 3 hours and 30 minutes, and those classified as Stage III during the hospitalization were seen after an average of 4 hours. The average time to management for patients transferred from the Emergency Department to the Intensive Care Unit was 4 hours. CONCLUSION: This study highlights the importance of early management of scorpion envenomation.

Pediatric scorpion envenomation in the United States: morbidity, mortality, and therapeutic innovations.

In the Southwestern United States, the venom of the scorpion Centruroides sculpturatus (common name bark scorpion) can cause serious and potentially fatal neurotoxicity, with young children most vulnerable to its effects. Historically, advances in the quality of supportive care have made significant improvements in morbidity and mortality. In recent years, the development of effective antivenom therapies has changed the landscape of caring for these patients. This article reviews the background, pathophysiology, diagnosis, and treatment options for C. sculpturatus envenomation. Recent advances in immunotherapy and subsequent implications for pediatric emergency care providers are discussed.

Lethal brain edema, shock, and coagulopathy after scorpion envenomation.

We report the case of a 2-year-old Bedouin boy in whom developed severe and unusual complications after being stung, most probably, by the yellow scorpion Leiurus quinquestriatus hebraeus. Five hours after arrival to the emergency department, the boy had multisystem organ failure involving the central nervous system (seizure activity followed by coma with dilated, nonreactive pupils, and severe brain edema), shock (noncardiogenic), disseminated intravascular coagulation, renal failure, hepatic failure, and watery diarrhea, causing his death. In view of the relevant literature, we discuss the pathophysiologic events ultimately leading to his death.

Vegas stings.

The case detailed here is relatively straight-forward. We describe the case of a tourist who sustained a scorpion sting in a local state park. Her symptoms were more significant than typically seen with simple scorpion stings. The scorpion that was caught by her boyfriend was later determined to be a bark scorpion. However, following adequate prehospital treatment and detailed evaluation in the emergency department, the patient improved. It was determined that scorpion antivenin wasn't indicated bacause of the lack of systemic signs and symptoms. The patient ultimately did well and completed her vacation in Las Vegas.

Epidemiological, toxicological and physiopathological characteristics of scorpion stings and their management in Morocco: A literature review.

All around the world, scorpion envenomation represents a public health issue. In Morocco, it represents the first cause of poisoning. The aim of this review is to highlight the epidemiological, toxicological and physiopathological characteristics of scorpion stings and envenomation in Morocco as well as their management. According to the bibliography, the most areas affected by scorpion stings and envenomation are those in the center and south of Morocco. Lethality rate is more important in children than adult. Age, admission class, season, serum venom concentration, and the time elapsed between the scorpion sting and medical intervention are risk factors for a poor prognosis. Until now, we have only known the LD50 of 14 scorpion species from three genera: Androctonus, Buthus and Hottentota, and only 6 species, out of 61 moroccan scorpions, have been assessed for their venom toxicity on mice organs. The venom of harmful moroccan scorpions induces several histopathological changes in the myocardium, brain, liver, pulmonary alveoli, and kidneys in rats, as well as severe consequences in the lungs with intra-alveolar hemorrhage. There was also a significant increase in serum enzyme levels of aspartate transaminase (AST), alanine transaminase (ALT), creatine phosphokinase (CPK), and lactate dehydrogenase (LDH), as well as high levels of plasma albumin, creatine and glucose. In the absence of a specific treatment, the management of scorpion envenomation is based only on symptomatic therapy. We noted a widely use of traditional remedies. Despite the magnitude of the scorpion problem in Morocco, it remains understudied and continues to claim lives, particularly given the lack of an efficient etiological cure.