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.

Development and characterization of a new carrier for vaccine delivery based on calcium-alginate nanoparticles: Safe immunoprotective approach against scorpion envenoming.

To enhance humoral defense against diseases, vaccine formulation is routinely prepared to improve immune response. Studies in nanomaterials as a carrier of vaccine delivery are promising and interesting. In this study, attenuated Androctonus australis hector (Aah) venom and its toxic fraction were encapsulated into different formulations inside calcium-alginate nanoparticles (Ca-Alg Nps), and used as a vaccine delivery system against scorpion envenomation. Ca-Alg Nps were prepared by ionic gelation and characterized. An immunization schedule was undertaken in rabbits in order to study how Aah venom entrapped in Ca-Alg Nps might induce protective immunity. Results showed the influence of different parameters on the suitable nanoparticle formation. They also showed no toxicity of free Ca-Alg Nps and a different inflammatory profile depending on the nanovaccine formulations. More interestingly, evaluation of specific IgG titer and IgG1/IgG2a isotype balance revealed a protective effect with the nanoparticles encapsulating the attenuated antigens. Challenge up to 6 LD 50 of native venom, allowed to an important immunoprotection of all immunized rabbits, with no recorded death. Taken together and with respect to the properties of nanoparticles and high immunogenicity, calcium-alginate nanoparticles could be considered as a new promising adjuvant system and a vaccine delivery against scorpion envenomation.

Pediatric envenomations: don't get bitten by an unclear plan of care.

Children are frequently victims of terrestrial animal and insect bites and stings. While the majority of these bites or stings are nondangerous, pediatric patients occasionally encounter a venomous animal. In such cases, children may present to the emergency department for evaluation and management. This review presents the basic epidemiology of bites and stings of spiders, bees and wasps, fire ants, scorpions, and snakes, but it primarily focuses on the underlying pathophysiology and clinical presentation of the envenomated patient. While the pathophysiology and much of the presentation and treatment are the same for both children and adults, there are occasionally subtle differences, which will be highlighted. The management and disposition of pediatric patients for each type of bite or sting will also be discussed.

[Scorpion envenomation treated in the Infectious and Tropical Diseases at the Donka National Hospital, Guinea]. / Les envenimations scorpioniques traitées dans le service des maladies infectieuses et tropicales de l'hôpital national Donka, Guinée.

A retrospective descriptive study was conducted from 1(st) October 2010 to 30 November 2012 on the records of patients admitted for scorpion envenomation in the Department of Infectious and Tropical Diseases at the Donka National Hospital. The objective of this study is to describe the epidemiological profile and clinical characteristics of scorpion envenomation in Maritime Guinea, from scorpion stings recently covered in this service. We collected 75 cases of scorpion envenomation. The median age was 21.5 with interquartile 8 and 20 and sex ratio was 1.29. The upper limbs were involved in 55% of cases, followed by the lower limbs (35%), trunk (6%), head and neck (4%). We observed 63% of patients with local signs, 30% mild and general clinical signs of 7% severe systemic symptoms. All patients received an analgesic and a heterologous antitoxin, associated with an antibiotic (87% of patients), a corticosteroid (72%), diazepam (13%) and furosemide (34.6%). The incidence of scorpion envenomation is not negligible despite underreporting of cases, most often treated in traditional medicine.

Treatment of scorpion envenoming syndrome -- need for scientific magnanimity.

Scorpion envenoming syndrome results in a severe autonomic storm with a massive release of catecholamines, increased levels of angiotensin II, an increase in glucagon, cortisol, thyroid hormones; either suppressed insulin levels or hyperinsulinaemia (insulin resistance), hyperglycaemia; increased circulating free fatty acid levels. These hormonal alterations could be responsible for the pathogenesis of a variety of clinical manifestations. Under these conditions, scorpion envenoming syndrome with myocardial damage, cardiovascular disturbances, peripheral circulatory failure, respiratory and cardiac pulmonary oedema, and many other clinical manifestations resulting in a syndrome of fuel-energy deficits and an inability to use the existing metabolic substrates by vital organs causing multisystem organ failure and death. Based on animal experiments in which insulin administration reversed the metabolic and ECG changes induced by scorpion envenoming and treating the poisonous scorpion sting victims with insulin, we consider that insulin has a primary metabolic role in preventing and reversing the cardiovascular, haemodynamic, and neurological manifestations and pulmonary oedema induced by scorpion envenoming. Administration of insulin-glucose infusion to scorpion sting victims appears to be the physiological basis for the control of the metabolic response when that has become a determinant to survival. The mordality of treatment is continuous infusion of regular crystalline insulin at the rate of 0.3 U/g glucose and glucose at the rate of 0.1g/kg body weight/hour, with supplementation of potassium as needed and maintenance of fluid, electrolytes and acid-base balance is required. This treatment should be given at the earliest on admission and continued for the next 48-72 hours. Antiscorpion serum could also be given independently or along with insulin-glucose infusion.

Immunological aspects of scorpion toxins: current status and perspectives.

Significant progress has been made in immunological studies of scorpion toxins and several formats of antibodies directed against scorpion toxins have been reported. Some of these are commonly used in a specific treatment against envenoming; others are primarily used for immuno-biochemical characterizations. The preparation protocol of the antibody or its fragments can be substantially different from one laboratory to another, which complicates a direct comparison of the potency of the antivenom. The use of immune sera, the total immunoglobulin fraction or Fab and Fab'2 fragments as the therapeutic agent is widespread. A number of monoclonal antibodies have also been reported and used for engineering of Fv, ScFv or Fab fragments. Recently, a novel antibody format - known as nanobodies - derived from HCAbs of camelids and selected after phage display shows great potential to provide a more efficient therapy against scorpion envenoming. Subsequent bispecific derivatives have been designed and their pharmacokinetics have been studied. Distinct advantages and disadvantages have been attributed to these equine, murine or camelid antibodies and their derived fragments. Some fragments are easily amenable into next generation therapeutics after proper manufacturing and provide an ensured availability of the product to the medical community. Through examples, we will show how the comparison of the serotherapeutic effectiveness is compromised due to the absence of standardization, on the preparation of immunogens, production processes and / or nature of the products. We will report on recent advances in the field.

[Scorpion puncture: medical treatment and home remedies]. / Alacranismo en Guerrero, México. Tratamiento médico y remedios caseros.

BACKGROUND: The scorpion puncture is a medical urgency. The greater frequency happens in Jalisco, Morelos and Guerrero. Controversy in the medical treatment persists, some use serum anti-scorpion, others only in critical cases. People by tradition are used the home remedies to cure the scorpion puncture. Our objective was to know the medical treatment and home remedies used in scorpion punctures in the State of Guerrero. METHODS: Retrospective, cross-sectional-descriptive, observational study through a non-probabilistic sample by quotas during a period of eight years with 1,174 patients with age above 18 years with a interview applied by medical students. RESULTS: All the affected patients used home remedies, 94% went to the physician, the more frequent remedies used were garlic, tobacco, cacahuananche, salt, eggs. The most frequent prescribed drugs were: antiscorpion serum, calcium, chloroquine, an antihistamine drugs. Of the total of affected patients, 45% were children and 53 % adults. CONCLUSIONS: In Guerrero, it is traditional to use different home remedies. Doctors used antiscorpion serum in the 56.73% of the cases and symptomatic treatment with different medications.

Scorpion envenoming in two regions of Colombia: clinical, epidemiological and therapeutic aspects.

To determine clinical and epidemiological features of scorpion stings in two departments of Colombia, a descriptive study was performed in the hospitals of 10 towns from Antioquia (2 256 071 inhabitants) and five from Tolima (630 424 inhabitants). One hundred and twenty-nine cases were admitted during one year, 51 in Antioquia, 78 in Tolima and 41 were children less than 15 years old. Most stings (70.5%) occurred inside the house; 27.9% were on the hands and 26.4% on the feet. The scorpion species involved were Tityus pachyurus (51), Centruroides gracilis (31), T. fuehrmanni (29), T. asthenes (7) and Chactas spp. (1). In 10 cases the scorpion involved was not identified. Systemic envenoming signs (e.g. vomiting, tachypnea) were significantly more frequent in children than in adults (P < 0.05). Four children had hypertension, but none developed pulmonary oedema. One 3-year-old girl, stung by T. asthenes, had acute oedematous pancreatitis. Ninety-eight patients had mild envenoming. Moderate (27 patients) and severe (four patients) envenoming was significantly more frequent in children than in adults (P = 0.003; relative risk = 2.97). A pepsin-digested anti-Centruroides spp. antivenom was administered to 19 of 31 patients presenting systemic envenoming signs. No adverse reactions to antivenom were observed.

[In vivo and in vitro protection against lethal activity of Buthus occitanus tunetanus venom with a recombinant protein]. / Induction de protection in vivo et in vitro contre l'activite létale du venin de Buthus occitanus tunetanus avec une protéine recombinante.

We report the use of recombinant scorpion toxin in the form of fusion protein as antigen for mice immunisation. The aim is to produce protective antisera against lethal activity of the venom from Tunisian scorpion Buthus occitanus tunetanus, responsible for several annually reported human cases of scorpion stings. The gene encoding Bot III (the most toxic alpha toxin of Buthus occitanus tunetanus) was fused to the sequence encoding synthetic ZZ domains of staphylococcal protein A. The construct ZZ-Bot III was expressed in the periplasm of E. coli as a fusion protein and purified by affinity chromatography. The recombinant fusion protein was characterized and used as antigen to generate antibodies in mice. The antibodies against the recombinant protein neutralize the toxic venom (10 LD50/ml) and also confer protection for immunized mice against antigenically related mammal toxins.

Ethnomedical information and in vitro screening for angiotensin-converting enzyme inhibition of plants utilized as traditional medicines in Gujarat, Rajasthan and Kerala (India).

Plants utilized as traditional medicines in India have been investigated for their ability to inhibit the angiotensin converting enzyme (ACE). In total, 75 species belonging to 42 families have been investigated and new ethnomedical information has been obtained for 41 species. Four species were found to possess a high ACE inhibiting ability and were low in their tannin content.

A survey from the literature of plants used to treat scorpion stings.

A catalogue of plants used to treat envenomation by scorpions has been compiled from a comprehensive range of over 30 reference books and review papers. Details of the parts used and the method of use are given, as well as the geographical source. The possible pharmacological and chemical basis of the use of some of the plants listed is discussed and compared with plants used to treat envenomation by snakes.