Aspectos epidemiológicos, clínicos y paraclínicos del accidente escorpiónico en el Hospital Universitario de Neiva, Colombia / Epidemiological, clinical and paraclinical aspects of the scorpion accident at the University Hospital of Neiva, Colombia

RESUMEN Objetivo: describir las características sociodemográficas, clínicas y paraclínicas de los pacientes atendidos en el Hospital Universitario de Neiva, entre los años 2014 y 2018 e identificar los factores de riesgo que se asocien con la mortalidad. Materiales y métodos: estudio observacional analítico retrospectivo. Se calcularon las medias, la desviación estándar, frecuencias absolutas y relativas. Se realizó un análisis de normalidad con el Test de Shapiro-Wilk. Se evaluó la asociación de diferentes variables sociodemográficas y clínicas con el riesgo de mortalidad usando regresión logística. Resultados: se registraron 305 eventos, predominantemente leves (117 casos). El 2018 fue el año con mayor número de reportes (35,45 %). La mayoría eran personas jóvenes con una edad media de 17 años, principalmente de los 0 a 11 años (61 %). Más del 90% eran pacientes residentes del departamento Huila y más de la mitad (67 %) pertenecían al régimen subsidiado. La mayoría de las picaduras ocurrieron durante el día, siendo las extremidades la ubicación más frecuentemente reportada (82 %). Se encontró una asociación estadísticamente significativa entre un cuadro grave y la mayor necesidad de UCI. Conclusiones: el escorpionismo es un problema de salud pública infravalorado en Colombia. La población pediátrica tiene mayor riesgo de desarrollar complicaciones y síntomas graves en la escorpiotoxicosis. Un cuadro grave en cualquier edad aumenta la probabilidad de ingreso a una UCI, requerimiento frecuente de soporte hídrico e inotrópico y la necesidad de antihipertensivos, al igual que dosis elevadas de antiveneno.

SUMMARY Objective: To describe the sociodemographic, clinical and paraclinical characteristics of the patients treated at the Neiva University Hospital between 2014 and 2018, and identify risk factors that are associated with mortality. Materials and Methods: Observational, analytic retrospective, study. Absolute and relative frequencies were calculated. Normality analysis was performed with the Shapiro-Wilk Test. The relationship of different sociodemographic and clinical variables and the risk of mortality were evaluated using logistic regression. Results: 305 events were registered, predominantly mild (117 cases), being 2018 the year with the highest number of reports (35.45%). Most were young people, with a mean age of 17 years, mainly between 0-11 years (61%). More than 90% resided in the Huila department and more than half (67%) belonged to the subsidized regime. Most bites occurred during the day, with the extremities being the most frequently reported location (82%). A statistically significant association was found between a severe condition and an increased need for an ICU. Conclusions: Scorpionism is an undervalued public health problem in Colombia. The pediatric population is at increased risk of developing severe complications and symptoms in scorpiotoxicosis. A severe condition at any age increases the probability of ICU admission, more frequent requirement for inotropic and liquids supply, and the use of antihypertensive drugs and high doses of anti-venom.

Vulnerabilities and clinical manifestations in scorpion envenomations in Santarém, Pará, Brazil: a qualitative study / Vulnerabilidades e manifestações clínicas em envenenamentos por escorpiões em Santarém, Pará, Brasil: estudo qualitativo / Vulnerabilidades y manifestaciones clínicas en envenenamiento de escorpiones en Santarém, Pará, Brasil: estudio cualitativo

Abstract Objective: To describe elements of vulnerabilities and clinical manifestations of the victims of scorpionism in Santarem-Pará. Method: Quantitative and qualitative study with a theoretical framework of Twenty-eight patients stung by scorpions were interviewed by applying a semi-structured instrument. Data were analyzed according to the technique of discourse analysis. Results: Seventeen patients (60.7%) were male and eight (28.6%) were illiterate. Twenty-two (78.5%) patients were small farmers. This study revealed that these patients had an important individual, social and programmatic vulnerability. Interviews revealed limited knowledge about prevention and first aid after the envenomation. Programmatic vulnerability is highlighted because there is difficulty in accessing health services due to the great geographical extension of the Amazon region and also a lack of experience of the health care workers in caring for scorpion sting victims. Conclusion: This research accurately reveals previously described neuromuscular and sensory nervous system disorders in these victims of scorpionism. As far as we know, this is the first study that addresses the vulnerability of scorpionism using qualitative methodology.

Resumo Objetivo: Descrever elementos de vulnerabilidades e manifestações clínicas das vítimas de escorpionismo em Santarém-Pará. Método: Estudo quantitativo e qualitativo, com referencial teórico de 28 pacientes picados por escorpiões, foram entrevistados mediante aplicação de instrumento semiestruturado. Os dados foram analisados ​​de acordo com a técnica de análise de discurso. Resultados: Dezessete pacientes (60,7%) eram do sexo masculino e oito (28,6%) eram analfabetos. Vinte e dois (78,5%) pacientes eram pequenos agricultores. O estudo revelou que esses pacientes apresentavam uma importante vulnerabilidade individual, social e programática. As entrevistas revelaram conhecimento limitado sobre prevenção e primeiros socorros após o envenenamento. A vulnerabilidade programática é destacada porque há dificuldade no acesso aos serviços de saúde devido à grande extensão geográfica da região amazônica e também à falta de experiência dos profissionais de saúde no atendimento às vítimas de picadas de escorpião. Conclusão: Esta pesquisa revela com precisão os distúrbios neuromusculares e sensoriais do sistema nervoso descritos anteriormente nessas vítimas de escorpionismo. Até onde sabemos, este é o primeiro estudo que aborda a vulnerabilidade do escorpionismo usando metodologia qualitativa.

Resumen Objetivo: Describir los elementos de vulnerabilidades y manifestaciones clínicas de las víctimas del escorpionismo en Santarem-Pará. Método: Estudio cuantitativo y cualitativo, con marco teórico de veintiocho pacientes picados por escorpiones, que fueron entrevistados mediante la aplicación de un instrumento semiestructurado. Los datos fueron analizados de acuerdo con la técnica de análisis del discurso. Resultados: Diecisiete pacientes (60.7%) eran hombres y ocho (28.6%) eran analfabetos. Veintidós (78,5%) pacientes eran pequeños agricultores. Este estudio reveló que estos pacientes tenían una importante vulnerabilidad individual, social y programática. Las entrevistas revelaron el reduzido conocimiento sobre la prevención y primeros auxilios después del envenenamiento. La vulnerabilidad programática se destaca porque hay dificultades para acceder a los servicios de salud debido a la gran extensión geográfica de la región amazónica y también la falta de experiencia de los trabajadores de salud en el cuidado de las víctimas de picaduras de escorpiones. Conclusión: Esta investigación eviencio con exactitud los trastornos neuromusculares y sensoriales del sistema nervioso descritos anteriormente en estas víctimas del escorpionismo. Hasta donde sabemos, este es el primer estudio que aborda la vulnerabilidad del escorpionismo utilizando la metodología cualitativa.

Escorpionismo no interior da Amazônia: geoespacialização e aspectos clínico-epidemiológicos / Scorpion envenomation in Amazon: Geospatialization and clinical-epidemiological aspects

Introdução: No Oeste do Pará os acidentes escorpiônicos evidenciam um quadro diverso das demais regiões do país, com manifestações neurológicas singulares, que acometem indistintamente todas as idades. Objetivo: Analisar a distribuição espacial e os aspectos clínico-epidemiológicos dos acidentes escorpiônicos no 9º e 10º Centro Regional de Saúde do Estado do Pará. Método: Trata-se de pesquisa observacional, descritiva, retrospectiva e prospectiva, com abordagem quantitativa, realizada em duas etapas. A primeira etapa teve delineamento retrospectivo e baseou-se em fichas de notificação dos municípios pertencentes ao 9º e 10º Centro Regional de Saúde, no período de 2011 a 2015, e prontuários de pacientes atendidos no Hospital Municipal de Santarém (HMS), em 2016. A segunda etapa, prospectiva, foi realizada por meio de pesquisa de campo junto aos indivíduos acometidos pelo agravo, no período de março a setembro de 2017. Testes estatísticos viabilizaram a análise descritiva e inferencial, além de realizar-se análise espacial. Resultados: Entre 2011 a 2015 foram notificados 6.997 casos de escorpionismo na região, sendo o último ano o que apresentou maior incidência, com 1.470 (21,0%) casos. O estudo prospectivo acompanhou 259 vítimas de escorpionismo em 18 municípios da região, uma vez que os municípios de Curuá e Faro não registraram casos. O perfil das pessoas acometidas revela maior concentração de casos na faixa etária entre 16 a 30 anos (29,0%), sexo masculino (69,0%), agricultores (34,0%), com renda até um salário mínimo (61,0%) e ensino fundamental incompleto (58,0%). A zona rural foi a área de maior ocorrência de casos (78%), principalmente ocorridos durante atividades laborais (42,0%). Os dados evidenciam vulnerabilidade individual e social dos indivíduos acometidos. Também verificou-se que, para a maior parcela dos casos, o intervalo de tempo entre a picada e a assistência foi de 1 a 3 horas (36,3%). As mãos (52,0%) foram os locais mais acometidos. As manifestações locais mais comuns foram: dor (99,0%), sensação de choque elétrico (51,0%) e parestesia (50,0%). As manifestações sistêmicas prevalentes reuniram sensação de choque elétrico (57,1%), formigamento (52,1%) e ataxia de marcha (34,3%). As manifestações neuromusculares duraram em média 24 horas. Houve diferença entre o tempo de atendimento levando em consideração a gravidade do caso. As espécies T. obscurus, T. strandi, T. silvestris foram as responsáveis pelos acidentes na região. A análise espacial revelou que 12 municípios apresentaram alto risco para o agravo. A maioria dos acidentes acompanhados foram classificados como leves (56,4%). Todos os pacientes evoluíram favoravelmente. Conclusão: O estudo apresenta importante achado, ao constatar que outras espécies de Tityus também foram responsáveis pelos acidentes que evidenciaram manifestações neuromusculares, com destaque para a sensação de choque elétrico. O estudo também contribui para que os profissionais de saúde reconheçam as características dos sinais e sintomas compatíveis com o agravo. A identificação do risco para o agravo, nos vários municípios em que ocorreu o estudo, demonstra a necessidade de que a população seja instrumentalizada a respeito de práticas de prevenção, destacando-se que o escorpionismo, na região em que ocorreu o estudo, acomete os grupos com maior vulnerabilidade individual e social.

Introduction: The accidents with scorpion envenomation in the West region of Pará evidence a diverse clinical picture of the other regions of Brazil with singular neurological manifestations affecting indiscriminately all ages. Objectives: Analyze the spatial distribution and clinical and epidemiological aspects of accidents with scorpions in the 9th and 10th Regional Health Center of the state of Pará, Brazil. Method: This is an observational, descriptive, retrospective and prospective research with a quantitative approach, held in two stages. The first stage had a retrospective design and was based on notification forms from the municipalities within the 9th and 10th Regionals of Health in the years 2011 to 2015 and on medical records of scorpion envenomation patients attended at Santarém City Hospital in 2016. The second stage was prospective and was a field research carried out with individuals affected by this accident from March through September 2017. In addition to a spatial analysis, statistical tests were applied making it possible to achieve a descriptive and inferential analysis. Results: During the period of 2011 and 2015, 6,997 cases of scorpion envenomation were reported in the region studied. The last year (2015) of the period presented highest incidence with 1,470 (21.0%) cases. The prospective study followed 259 victims of scorpion envenomation in 18 of the 20 municipalities in the region studied, once the municipalities of Curuá and Faro did not report any cases. The profile of the people affected shows a higher concentration of cases in the age group between 16 and 30 years (29,0%), males (69.0%), farmers (34.0%), with income up to one minimum wage (61.0%), and incomplete elementary school (58.0%). The rural area had the higher occurrence of cases (78%), mainly during labor activities (42.0%). Data demonstrate individual and social vulnerability of the affected individuals. It was also found that for the most of the cases the time between the sting accident and medical assistance was of 1 to 3 hours (36.3%). Hands (52.0%) were the most affected sites. The most common local symptoms were: pain (99.0%), sensation of electric shock (51.0%) and paresthesia (50.0%). The prevalent systemic signs were a sensation of electric shock (57.1%), tingling (52.1%) and gait ataxia (34.3%). The neuromuscular manifestations of the victims lasted on average 24 hours. Happened Difference between the time of attendance taking into account the severity of the case. It was demonstrated the relation between the time elapsed till medical assistance and the consequent aggravation of the case. The accidents were caused by the species T. obscurus, T. strandi, T. silvestris in the region studied. The spatial analysis revealed that twelve municipalities have a high risk for the aggravation. Most of the accidents followed were classified as light (56.4%). All patients evolved favorably. Conclusion: The study presents an important finding, pointing that other species of Tityus were also responsible for the accidents that evidenced neuromuscular manifestations, featured the sensation of electric shock. The study also helps health professionals to recognize the signs and symptoms compatible with the aggravation. The identification of the risk to the aggravation, in the various municipalities in which the study occurred, demonstrates the need for the population to be instrumentalized regarding prevention practices, highlighting that the scorpion envenomation, in the region where the study occurred, affects the groups with greater individual and social vulnerability.

Predictive determinants of scorpion stings in a tropical zone of south Iran: use of mixed seasonal autoregressive moving average model

Background: More than 1.2 million scorpion stings occur annually worldwide, particularly in tropical regions. In the absence of proper medical care, mortality due to venomous scorpion stings is an important public health issue. The aim of the present study is to explore the temporal trend of scorpionism with time series models and determine the effective factors on this event using regression models. Methods: A retrospective cross sectional study was conducted on 853 scorpion stung patients. They were referred to Haji-Abad Hospital of Hormozgan University of Medical Sciences (HUMS), south Iran, from May 2012 to July 2016. A linear model to describe and predict the monthly trend of scorpion sting cases is fit with autoregressive moving average (ARMA) model. Results: Of 853 victims, 384 (45%) patients were female and 30.2% of them lived in urban areas. The mean (± SD) age of patients was 30.1 (± 19.6) years and the most affected age group was 20-29 years (21.8%). Most victims were unemployed people and farmers (54.7%) followed by housewives (30.2%). The majority of the stings occurred indoors (53.7%), between midnight and 6 a.m. (29.2%), in the summer (44.2%), and the most affected limbs were hands and legs (81.2%). Patient genders and occasions of being stung by scorpions were significantly different between outdoors and indoors (p < 0.001). Scorpion stings due to Odontobuthus doriae were significantly higher than due to other species in urban and rural patients (p = 0.04). Mixed seasonal ARMA at lag 12, ARMA (1, 1) x (0, 1), was selected as the best process for monthly trend of data. Regression results indicated that significant climate factors associated with scorpion stings are temperature (p < 0.001) and relative humidity (p = 0.002). Conclusions: Scorpion stings have a noticeable effect on tropical rural populations, mainly farmers. Two effective climate factors associated positively and negatively with scorpion sting cases are temperature and relative humidity, respectively. The results of time series and regression models to predict the trends and determinants of scorpion stings are almost the same.(AU)

Spatial temporal study of scorpion envenomation in the state of Sergipe, Brazil / Estudo espacial e temporal dos envenenamentos por escorpiões no estado de Sergipe, Brasil

This is a descriptive, retrospective study using a quantitative approach based on secondary data from records related to scorpion envenomation from the Notifiable Diseases Information System (SINAN ­ Sistema de Informação de Agravos de Notificação) from 2004 to 2014. The goal was to determine the frequency of scorpion envenomation in the eight territories of the state of Sergipe and to examine spatial differences and environmental influences on envenomation. The study was conducted in the state of Sergipe, Brazil and analysed the relationship between locations most affected by scorpion stings and anthropogenic changes. The following variables were analysed: month and year of the envenomation, territory, area of the envenomation and population according to Brazilian Institute of Geography and Statistics (IBGE - Instituto Brasileiro de Geografia e Estatística). Territorial changes were observed in the neighbourhood of Santos Dumont, in the municipality of Aracaju, that were caused by human occupation in the years 2003, 2009 and 2014. To analyse the climatic influences on the frequency of scorpion stings, we used the normal temperature and normal rainfall in the municipalities of Sergipe, especially in Canindé de São Francisco, Nossa Senhora das Dores and Aracaju, provided by the National Institute of Meteorology and Technology (INMET ­ Instituto Nacional de Meteorologia e Tecnologia). A total of 8021 accidents with poisonous animals occurred in Sergipe between 2004 and 2014, of which 5133 (63.99%) involved scorpions; 80% of scorpion envenomation in Sergipe occurred in urban areas, with significant differences in the distribution per zone between the territories (P<0.01). The territory of Grande Aracaju (87.9%) had the highest frequency on scorpion envenomation in urban areas, Alto Sertão (55.9%) had the highest frequency in rural areas, and the municipality of Aracaju had 58.11% of all cases of scorpion stings in Sergipe. The neighbourhood of Santos Dumont was the most affected in the municipality of Aracaju, with 219/2983 cases. Regarding preventive measures aimed at the population, it is recommended that individuals maintain cleanliness in the vicinity of their households, avoid accumulating construction waste, use wall coatings, use protective screens in drains and sewers, and seal septic tanks; individuals may also preserve the scorpions' predators.

Estudo descritivo, retrospectivo de abordagem quantitativa com base em dados secundários, extraídos das notificações de envenenamentos por escorpião no Sistema de Informação de Agravos de Notificação (SINAN) no período de 2004 a 2014. O objetivo foi determinar a frequência de envenenamentos por escorpiões nos oito territórios sergipanos, verificando as diferenças espaciais nas ocorrências e as influências ambientais sobre os envenenamentos. O estudo foi realizado no Estado de Sergipe, Brasil, e analisou a relação entre localidades mais acometidas por acidentes escorpiônicos e modificações antrópicas. As variáveis analisadas foram: ano e mês do envenenamento, território, zona de ocorrência e população segundo Instituto Brasileiro de Geografia e Estatística (IBGE). Verificaram-se as modificações territoriais no bairro Santos Dumont, no município de Aracaju, causadas pela ocupação humana nos anos de 2003, 2009 e 2014. Para analisar as influências climáticas nas frequências de envenenamentos por escorpiões, utilizou-se as normais de temperatura e normais de pluviosidade dos municípios de Sergipe, em especial Canindé do São Francisco, Nossa Senhora das Dores e Aracaju, fornecidos pelo Instituto Nacional de Meteorologia e Tecnologia (INMET). Verificou-se a ocorrência de 8021 casos de acidentes com animais peçonhentos em Sergipe no período entre 2004 e 2014, dos quais 5133 (63,99%) envolveram escorpiões; 80% dos casos de acidentes escorpiônicos em Sergipe, ocorreram em zona urbana, com diferenças estatísticas na distribuição por zona entre os territórios (p0,01). O território da Grande Aracaju (87,9%) apresentou a maior frequência de envenenamentos em zona urbana; o Alto Sertão (55,9%) obteve a maior frequência em zona rural; o município de Aracaju concentrou 58,11% de todos os casos de acidentes escorpiônicos de Sergipe. O bairro Santos Dumont foi o mais acometido do município de Aracaju com 219/2983 casos. Em relação às medidas preventivas voltadas à população é recomendável orientar sobre a manutenção da limpeza no entorno dos domicílios; evitar resíduos de construção civil; realizar o acabamento das paredes através de revestimentos; utilizar telas protetoras nos ralos de esgotos e manter fossas sépticas lacradas, além de preservar os predadores dos escorpiões.

Spatial distribution of scorpions according to the socioeconomic conditions in Campina Grande,State of Paraíba, Brazil

Abstract: INTRODUCTION: Due to its frequency and morbidity, such as that caused by scorpions have achieved public health importance in certain regions of the world. The present exploratory ecological study aimed to characterize the epidemiological profile and spatial distribution of scorpion stings in Campina Grande, State of Paraíba in Northeastern Brazil. METHODS: Geographical information system techniques were used to record the scorpion stings, and Google Earth software, Track Maker, and ArcGIS 10 Esri were used as geocoding databases. The Moran test was used to evaluate spatial correlation, and the Pearson chi-square test was used to analyze associations between scorpion stings and socioeconomic variables. RESULTS: The study evaluated 1,466 scorpion stings. Envenomations were more frequent among women (n = 908, 61.9%), and most patients were aged 13-28 years (n = 428, 29.2%). The Southern region of the city had the largest number of registered cases (n = 548, 37.4%), followed by the Western region (n = 510, 34.8%). CONCLUSIONS: Spatial analysis of scorpionism revealed an irregular occurrence in Campina Grande. Further, no association was observed between the socioeconomic factors analyzed and the geographic location of the scorpion envenomations. Detection of spatial areas with an increased risk of scorpionism can help prioritize adoption of preventive measures in these regions to reduce the associated incidence and morbidity.

Clinical and epidemiological aspects of scorpion stings in the northeast region of Brazil / Aspectos clínicos e epidemiológicos dos acidentes escorpiônicos na região do nordeste do Brasil

Scorpion stings are a serious public health issue in tropical and subtropical countries. This is a descriptive and retrospective study of the clinical-epidemiological characteristics of scorpion sting cases registered in the Health System in the city of Campina Grande, Paraíba state, from 2007 to 2012. Data was collected from the Injury Notification Information System data banks of the Ministry of Health. A total of 2,283 records, provided by the Third Health Sector of Campina Grande, were analyzed. Data revealed that the majority of the victims are female aged between 20 and 29 years, and the highest incidence of stings was in the urban area. Victims were mostly stung on the feet and hand. Serotherapy was not administered in most cases. The majority of the victims received medical assistance within 1 to 3 hours after the sting. The most prevalent clinical manifestations were pain, edema and paresthesias. Most cases were classified as mild, though seven deaths were reported. The high incidence rate suggests that this town may be an endemic area of scorpion stings, supporting the need to develop strategies to control and prevent scorpion stings.

Os acidentes escorpiônicos constituem um grave problema de saúde pública em países tropicais e subtropicais. Este estudo retrospectivo analisou as notificações dos acidentes escorpiônicos registrados no Sistema de Saúde do município de Campina Grande, no estado da Paraíba, de 2007 a 2012. As informações foram coletadas do banco de dados do Sistema de Informação de Agravos de Notificação do Ministério da Saúde. Foram analisadas 2283 fichas de notificação. Os dados revelaram que a maioria dos acidentados é do sexo feminino, com idade entre 20 e 29 anos. Os acidentes foram mais frequentes em área urbana, sendo os pés e as mãos os locais anatômicos do corpo mais atingidos pelas picadas. A soroterapia não foi administrada na maioria dos acidentados e as vítimas prevalentemente recorreram aos sistemas de saúde dentro do período de 1 a 3 horas após o acidente. As manifestações clínicas mais frequentes foram dor, edema e parestesias. A maioria dos acidentes foi classificada como leve, porém foram registrados 7 casos de óbito. A elevada taxa de incidência de acidentes escorpiônicos sugere que esse município pode ser uma área endêmica de escorpiões, justificando a necessidade da elaboração de estratégias de controle e prevenção de acidentes por estes animais.