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Failure of sub-arachnoid block (SAB), due to resistance to bupivacaine after a recent scorpion sting can lead to multiple block attempts and subsequent conversion to general anaesthesia. We report this case series of 10 patients with successful SAB with newly launched 0.75% hyperbaric ropivacaine, in patients with recent scorpion sting. Thus, intrathecal hyperbaric ropivacaine may be considered as the local anaesthetic agent of choice in patients with scorpion sting to prevent failure of SAB. [ABSTRACT FROM AUTHOR]

Scorpion stings pose a significant public health concern in Iran, resulting in approximately 45,000-50,000 cases and 19 deaths annually. The Khuzestan and Hormozgan provinces have the highest reported incidence rates, with an estimated 36,000 cases each year. This study focused on modeling the time series data of scorpion stings, specifically in Shoushtar City, from 2017 to 2022. Our objective was to investigate the presence of seasonality and long-term trends in the incidence of scorpion stings by utilizing advanced analytical techniques, such as the Autoregressive Integrated Moving Average (ARIMA) model. We applied the seasonal ARIMA model to fit a univariate time series of scorpion sting incidence. This study revealed a significant seasonal trend and an overall increase and decrease in scorpion sting cases during the study period. The best-fitting model for the available data was a seasonal ARIMA model in the form of ARIMA(0,0,1)(1,1,1)12. This model can forecast the frequency of scorpion sting cases in Southwestern Iran over the next two years. As a result, time series analysis can provide valuable insights into the patterns and trends of scorpion sting incidents, allowing for better planning and allocation of healthcare resources. By understanding the seasonal variations, proactive measures can be implemented to address the growing issue of scorpion stings in Iran effectively. [ABSTRACT FROM AUTHOR]

Background: Many unusual and fascinating causes of stroke are seen in Asia. Although rarely encountered in the Western world, such cases are seen not so infrequently by neurologists, physicians, and other healthcare workers in Asian countries. This article highlights some of these intriguing causes of stroke such as snakebite, scorpion stings, and bee and wasp stings. Summary: Snakebite is a neglected tropical disease of global importance affecting over 5 million people each year, and scorpion stings and bee and wasp stings affect over a million people worldwide every year. Strokes due to these uncommon causes predominantly affect young males in their most productive years, and many victims die or remain with residual disability with significant socioeconomic consequences to the affected families and society. Both ischaemic and haemorrhagic strokes are seen, with ischaemic strokes being more common. Many unanswered questions remain regarding the pathophysiological mechanisms, clinical spectrum, and the natural history of stroke due to these causes. Antivenom is effective in snake envenoming, antivenom and prazosin are effective in scorpion envenoming, and treatment of anaphylaxis and allergy is recommended in systemic reactions due to bee or wasp stings. However, there are no treatment guidelines or expert recommendations to guide the management of stroke in these patients, and there are no data on the safety and efficacy of stroke-specific treatments such as antiplatelet therapy, thrombolysis or endovascular treatment. Key Messages: More research is clearly needed to unravel the complexities related to stroke following snakebite, scorpion envenoming, and bee and wasp stings, and to guide the development of optimal stroke treatment strategies in these unusual situations. Awareness of these exotic stroke aetiologies is important in early recognition and appropriate management of patients presenting with stroke symptoms in Asian countries, and in global travellers from the region. International collaborations would go a long way in improving our understanding of these rare but fascinating causes of stroke.

Scorpion stings are a common medical emergency in many parts of the world. However, no statistical records are available about the incidence of scorpion sting envenomation and related mortality rates in the Sudan. This study aimed to describe the burden in the Sudan and to highlight the most affected states. We extracted retrospective hospital-based data on scorpions' stings envenomation for the years 2014–2018 from the annual statistical reports of the Federal Ministry of Health, Republic of the Sudan. Descriptive statistics were used to analyze the extracted data and elucidate the results. A total of 129,427 people were envenomed during 2014–2018 with a mean of 25,885 cases/year. More adults were stung compared to children. However, mortality was higher among children younger than 15 years old 4.7% (186/3974) than older victims 1% (56/5371). Envenomation was more frequent in males (56%) than females (44%). The Northern state reported the highest incidence of scorpion stings (344 per 100,000 population), followed by the River Nile state (240 per 100,000 population), and Khartoum state (174 per 100,000 population). Fatalities amongst hospitalized patients were 2.6% (242/9345) with the Northern state accounting for 34% (0.8/2.3) of total fatalities reported. [ABSTRACT FROM AUTHOR]

AbstractScorpion stings are a common medical emergency in many parts of the world. However, no statistical records are available about the incidence of scorpion sting envenomation and related mortality rates in the Sudan. This study aimed to describe the burden in the Sudan and to highlight the most affected states. We extracted retrospective hospital-based data on scorpions’ stings envenomation for the years 2014–2018 from the annual statistical reports of the Federal Ministry of Health, Republic of the Sudan. Descriptive statistics were used to analyze the extracted data and elucidate the results. A total of 129,427 people were envenomed during 2014–2018 with a mean of 25,885 cases/year. More adults were stung compared to children. However, mortality was higher among children younger than 15 years old 4.7% (186/3974) than older victims 1% (56/5371). Envenomation was more frequent in males (56%) than females (44%). The Northern state reported the highest incidence of scorpion stings (344 per 100,000 population), followed by the River Nile state (240 per 100,000 population), and Khartoum state (174 per 100,000 population). Fatalities amongst hospitalized patients were 2.6% (242/9345) with the Northern state accounting for 34% (0.8/2.3) of total fatalities reported.

ABSTRACT We report the first pediatric case of a Jaguajir agamemnon scorpion sting. This case occurred in the state of Paraná and is the first record of this species in southern Brazil. The patient was admitted within 15 min, with pain, local edema, erythema, whole-body pruritus, and tongue paresthesia within the first two hours, which disappeared thereafter. The patient’s condition was considered mild, with a positive outcome, and she recovered completely.

Background: Envenomation caused by snakebites and scorpion stings is a neglected disease responsible for significant morbidity and mortality. In Qatar, little information is available on the epidemiological aspects of snakebites and scorpion stings. This study describes the demographic and epidemiological characteristics of patients treated for scorpion stings or snakebites at Qatar's Primary Health Care Corporation (PHCC). Methods: A retrospective data analysis was applied to investigate the number of scorpion stings and snakebites reported at the PHCC health centers between January 1, 2018, and December 31, 2022. The data were electronically extracted from the medical records of the registered population at PHCC. Results: 581 scorpion stings and 21 cases of snakebites were reported between January 1, 2018, and December 31, 2022. The highest number of scorpion stings reported in 2020 was 141 cases. The distribution of scorpion stings was higher among males than females, with rates of 86% and 14%, respectively, and the highest number of cases occurred in the age group of 19-39 years. Among the total cases, Bangladeshi and Qatari were the most affected, with a rate of 41% and 14%, respectively. The western region had the highest incidence of scorpion stings, at 7.47 per 10,000 persons. Conclusion: According to this research, the western region had the highest occurrence of scorpion stings cases, primarily among Bangladeshis and Qataris, particularly in the age group of 19-49 years. This study also found similar patterns in snakebite cases. Consequently, this study emphasizes the need for increased investment in antivenom and the training of healthcare professionals to address scorpion stings effectively. [ABSTRACT FROM AUTHOR]

Abstract Objective: to describe the completeness of notifications of accidents involving venomous animals held on the Notifiable Health Conditions Information System (SINAN), in Brazil and its macro-regions, from 2007 to 2019. Methods: we analyzed essential and non-mandatory fields for snakebite, spider bite and scorpion sting notifications, considering the following completeness categories: Excellent (≤5.0% incompleteness), Good (5.0% to 10.0%), Regular (10.0% to 20.0%), Poor (20.0% to ≤50.0%) and Very Poor (>50.0%). Proportional change in completeness between 2007 and 2019 was estimated. Results: 1,871,462 notifications were investigated. The “localized manifestations”, “systemic manifestations”, “case classification”, “case progression” and “zone of occurrence” fields had excellent or good completeness. Completeness was regular or poor for the “schooling” and “race/color” fields. The “occupation” field was predominantly poorly or very poorly filled in. There was a proportional worsening in completeness (PC

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objectives: to analyze the epidemiological and clinical aspects of accidents caused by venomous animals in children under 15 years old. Methods: a cross-sectional study with an analytical component using secondary data from Centro de Informação e Assistência Toxicológica de Pernambuco (CIATox-PE), (Poison Center in Pernambuco)), in 2017 to 2019. Notifications of accidents caused were included in the studied age group and evaluated the characteristics of poisoning (animal classification, exposure zone, place and time of the occurrence and specific use of serum therapy), and of the patient (sociodemographic variables, clinical condition and evolution). The analysis performed in STATA® 13.1 presents frequency distribution tables and Pearson’s chi-square for comparison. Results: of the 2678 notifications, 82,8% were scorpionism and 10, 8% snakebite. The age group of1 to 9 years old (70.5%) and being male (54.1%) were predominant. Most of the cases occurred in urban area (80.9%), in Recife (67.3%), inside the victim’s residence (83.9%) and at night (47.3%). The majority (87.1%) were classified as ‘mild severity’, 10% received antivenom therapy and one died (by scorpionism). Two cases of snakebite in the workplace were registered. Conclusion: there was a high frequency of accidents caused in the urban area, which may be related to the lack of urban planning and sanitary education. The accidents caused among children in the household environment and the suspicion of child labor in the age group of 10 to 14 years old were also highlighted which favors the development and habits of the venomous animal.

Background and Objectives: This study aims to investigate the knowledge, attitude and practice (KAP) of residents in south of Kerman province in Iran regarding scorpion sting and the factors affecting its prevalence. Methods: This cross-sectional study was conducted in 2020 on 384 people living in south of Kerman province, Iran. A KAP questionnaire was used which surveyed the necessary information regarding the familiarity of residents with scorpions, the level of exposure to scorpions and effective factors, and knowledge of basic measures against scorpion stings. The questionnaire was completed through an interview. Data were analyzed using descriptive and inferential statistics. Results: The results showed the participants’ high knowledge of scorpion shelters (87.9%). Their most common measures in dealing with scorpion stings were hospitalization, use of cold compresses, moving away from the scene, covering the sting area with a cloth, washing the sting site, and applying pressure over the sting site. Most of participants (81.6%) suggested that spraying insecticides and the use of petroleum products were the main methods for getting rid of scorpions. About 31% had belief in traditional medicine. Most of them (73.5%) had found scorpions in their houses and 36.7% reported a history of scorpion sting in the family members. Most of them (64%) had got stung indoors. Moreover, 74.8% of them had houses with no walls or with unfavorable fencing, and for 78.3%, they were not safe in terms of scorpions entering. Conclusion: The measures and training for prevention and control of scorpion stings in south of Kerman province are necessary due to the high exposure of residents to scorpions indoors, the unsafety of their houses, and lack of compliance to preventive measures.

Accidents caused by venomous animals, especially scorpions, are a major public health problem due to the increase in incidence in recent decades, since scorpion species have become well adapted to urbanized environments. Nonetheless, the impact of urbanization in scorpionism is not clear. The objective of this study is to correlate the variation in the incidence of scorpion accidents with the rate of urbanized area. This was a retrospective, epidemiological study of accidents by scorpions in 376 of the most populous Brazilian cities in 2019 and compared to ten years earlier, using Spearman's correlation coefficient. Data were obtained by accessing DATASUS /TABNET and IBGE Cidades platforms. A weak negative correlation between scorpion stings and urbanization was found in 2009 (r s = −0.145). The correlation between the variation in the incidence of scorpionism and the percentage of urbanized area was not significant. Although the highest incidence of scorpionism occurs in-more urbanized environments, there is a wide distribution of scorpion accidents, especially in tropical and subtropical regions due to climatic conditions, the level of urbanization of Brazilian municipalities was not the major factor in the increase of scorpion accidents. [Display omitted] • Brazil is facing an increasing incidence of scorpion accidents. • There are population and structural aspects related to scorpionism. • Significant and disorderly increase in urbanization may be related to this public health problem. • Our study found a weak negative correlation between the percentage of urbanized area and the incidence of scorpion accidents. [ABSTRACT FROM AUTHOR]

Scorpionism is a serious public health problem in several parts of the world including Morocco, where is considered as the first cause of intoxication. The Beni Mellal-Khenifra region is one of the most affected regions by this health problem. The aim of this study is to describe the epidemiological and faunistic characteristics of scorpionism in this area. A retrospective epidemiological study was conducted based on the data of 16,388 cases of scorpion stings recorded between 2016 and 2020. In the laboratory, the collected scorpions were determined morphologically based on the valid taxonomic keys. Statistical and descriptive analyses were performed using Excel 2016. Statistical significance was determined by P-value < 0.05. The study comprised 16,388 stung patients. The scorpion stings incidence was 123.58 cases/100,000 population/year and was significantly higher at Azilal province (217.69 cases/100,000 population/year). We found a positive correlation between the scorpion stings incidence and the percentage of the rural population (r = 0.72) and between the scorpion stings incidence and the number of harmful species found in each province (r = 0.69). The general lethality rate was on average of 0.30% with a higher rate in Fquih Ben Salah province (0.63%) followed by Azilal province (0.32%). Children have the highest lethality than adults (p < 0.05). In the study area, eight species were identified, belonging to the families Buthidae and Scorpionidae, including dangerous species. Scorpionism is a real health problem in the Beni Mellal-Khenifra region, which is a rich and diverse area of scorpion fauna. Our findings can be useful for better understanding the problem of scorpionism in this region in order to better control it. [Display omitted] • The first study in the Beni Mellal-Khenifra region, central Morocco. • A positive correlation between the scorpion stings incidence and the percentage of the rural population. • Children have the highest lethality than adults. • Eight species were identified, including dangerous species known by the high toxicity of their venoms. [ABSTRACT FROM AUTHOR]

Sixty-seven scorpion species have been described in France and its territories, where they have been found to be heterogeneously distributed. Indeed, only one species can be found on Réunion Island, while 38 species exist in French Guiana. The number of stings is also heterogenous, with up to 90 stings per 100,000 inhabitants occurring annually. Scorpion species can frequently be determined through simple visual factors, including species of medical importance (i.e., Buthus, Centruroides and Tityus). Scorpion venom is composed of local enzymes and peptides with a cysteine-stabilized α/β motif (NaTxs, Ktxs, Calcines), which allow for venom diffusion and the prey's incapacitation, respectively. Harmful scorpion species are limited to Centruroides pococki in the French West Indies, which can induce severe envenoming, and the Tityus obscurus and Tityus silvestris in French Guiana, which can cause fatalities in children and can induce severe envenoming, respectively. Envenomation by one of these scorpions requires hospital monitoring as long as systemic symptoms persist. Typical management includes the use of a lidocaine patch, pain killers, and local antiseptic. In the case of heart failure, the use of dobutamine can improve survival, and pregnant women must consult an obstetrician because of the elevated risk of preterm birth or stillbirth. France does not have scorpion antivenom, as scorpion stings are generally not fatal. [ABSTRACT FROM AUTHOR]

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 re-trospective, 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 associa-tion 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.

Accidents caused by scorpions represent a major health problem on planet, both in individual terms and in the public health sphere. Morbid events can occur in different manifestations, and different clinical conditions must be differentiated for adequate treatment. In addition to the potential injury to human hosts, scorpion venom has been investigated for the therapy of several illnesses. Based on these aspects, the present article aims to present the clinical, diagnostic, therapeutic and prophylactic aspects of scorpionism.

This study analyzed a total of 260 confirmed scorpion stings reported in the city of Manaus, in the Brazilian Amazon, from 1990 to 2020. Cases were mapped according to the GPS location of their occurrence and plotted on a satellite image of the city. The stings generally occurred close to green areas, and the hotspots of stings moved north as city grew into that direction over time. Spatial analysis shows that scorpion stings mostly occur in poor, recently urbanized areas. The rapid and unplanned urbanization of originally forested areas, without offering adequate infrastructure and services, creates favorable conditions for infestation by scorpions and increases the risk of scorpion stings. • In the Brazilian Amazon scorpion stings predominate in urban areas. • Tityus metuendus is the main agent of scorpion envenomings in Manaus. • Scorpion stings were reported mostly in recent poor urbanized areas. • Deforestation and disorganized urbanization create an environment conducive to scorpions' reproduction. [ABSTRACT FROM AUTHOR]

The impact of Covid-19 on envenomations by venomous animals in countries heavily affected by both conditions has not been quantified yet. Brazil shows high incidence of envenomations by scorpions, spiders and snakes and was heavily affected by waves of Covid-19. To determine how the pandemic impacted the epidemiology of envenomations by those three groups of venomous animals, we used online databases from two surveillance sources on number of cases and mortality. During the years before and during the pandemic, scorpion stings typically occurred in adults of both sexes in urban zones in the Southeast and Northeast regions. Spider bites occurred mainly in the South region, in adults of both sexes in urban zone. Snakebites affected mainly rural adult men in the Amazon. Between 2007 and 2021, overall incidence of cases by scorpions, spiders and snakes decreased after the beginning of the pandemic, snakebites did not show changes after the pandemic started in Brazil, but cases by scorpions and spiders decreased. No changes in the incidence of deaths were observed. On national level, Covid-19 affected some demographic, clinical and epidemiological aspects in cases by scorpions, spiders and snakes. [Display omitted] • Epidemiology of snakebites, scorpion stings and spider bites did not change with the Covid-19 pandemic in Brazil. • Incidence of snakebites did not change among both periods. • Incidence of scorpion stings and spider bites decreased after the beginning of the pandemic. • Mortality of cases did not change in any of the three groups of animals. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the general characteristics and warning signs for the more severe (grade 3) clinical course in severe scorpion envenomations in the pediatric intensive care unit (PICU). Methods: This retrospective, cross-sectional study was conducted in 12 beds tertiary care PICU in Antalya Training and Research Hospital. Patients admitted to the PICU between 2017-2021 due to severe scorpion envenomation were admitted to the study. Results: It was found that there were 2,208 admissions to the intensive care unit during the study period (4 years), and 73 (3.3%) of these cases (35 female and 38 male) were followed up for severe scorpion envenomation. The median age was 52 (26-89) months. Yellow scorpions were described by parents or eyewitnesses in 65 patients (89%) and black scorpions in 8 (11%). Peripheral sympathetic activity (cold extremities, diaphoresis) signs (n=55, 75.3%), hypertension (n=35, 47.9%), and tachycardia (n=21, 28%) were the most common findings. The most common echocardiographic findings were mild-to-moderate mitral regurgitation and systolic dysfunction in 31 (42.5%) and 19 (25.9%) cases, respectively. Sixty-two (89%) patients had grade 2 envenomations findings and 12 (11%) had grade 3. High pro-BNP, hyperglycemia, and hyperamylasemia were observed more frequently in grade 3 than in grade 2 patients on admission. All patients received anti-venom therapy and 7 (9.5%) of them required a second dose of anti-venom therapy due to the unregressed clinical course. Twenty-seven patients (37%) required inotropics, s and the most commonly used inotropics were milrinone in 17 (23.3%) patients and dobutamine in 12 (16.4%) patients. The median PICU length of stay was 4 (3-5) days and the median hospital stay was 5 (4-6) days. All patients survived to discharge. Conclusion: Hyperamilasemia, hyperglycemia, and elevated pro-BNP levels on admission may be warning signs of more severe (grade 3) patients. Mild-to-moderate mitral regurgitation may be more commonly observed echocardiography findings than systolic dysfunction in severe cases (grade 2 and 3). [ABSTRACT FROM AUTHOR]

Objectives: to analyze the epidemiological and clinical aspects of accidents caused by venomous animals in children under 15 years old. Methods: a cross-sectional study with an analytical component using secondary data from Centro de Informação e Assistência Toxicológica de Pernambuco (CIATox-PE), (Poison Center in Pernambuco)), in 2017 to 2019. Notifications of accidents caused were included in the studied age group and evaluated the characteristics of poisoning (animal classification, exposure zone, place and time of the occurrence and specific use of serum therapy), and of the patient (sociodemographic variables, clinical condition and evolution). The analysis performed in STATA® 13.1 presents frequency distribution tables and Pearson's chi-square for comparison. Results: of the 2678 notifications, 82,8% were scorpionism and 10, 8% snakebite. The age group of1 to 9 years old (70.5%) and being male (54.1%) were predominant. Most of the cases occurred in urban area (80.9%), in Recife (67.3%), inside the victim's residence (83.9%) and at night (47.3%). The majority (87.1%) were classified as 'mild severity', 10% received antivenom therapy and one died (by scorpionism). Two cases of snakebite in the workplace were registered. Conclusion: there was a high frequency of accidents caused in the urban area, which may be related to the lack of urban planning and sanitary education. The accidents caused among children in the household environment and the suspicion of child labor in the age group of 10 to 14 years old were also highlighted which favors the development and habits of the venomous animal. [ABSTRACT FROM AUTHOR]

Purpose: The main aim of this study is to estimate the economic burden and prevalence of bites and stings injuries in Saudi Arabia. Methods: A retrospective, cross-sectional study was conducted at King Saud University Medical City (KSUMC) for all bites and stings cases presented to the Emergency Department (ED) between the period June 2015 and May 2019. Results: A total of 1328 bites and stings cases were treated in the ED at KSUMC. There were 886 insect bites and stings cases, 376 animal bites, 22 human bites, 34 scorpion stings, and ten snakebites. Most cases were reported in April - June. Females account for 62% of the reported cases, and the mean age was 24 years old. The total management cost of bite and sting cases during the study period was 3.4 million Saudi Riyal (SR). The spending cost of the management of animal bites was the highest as it cost 1,681,920.76 SR, followed by insect's management costing 1,228,623.68 SR. Conclusion: Bites and stings have a considerable health care burden on our society. Although the vast majority of the cases were not associated with a severe life-threatening condition, many were visit ED and associated with high medical costs. Increased awareness of the hazards of animal-related injuries, especially during spring and summer, where most cases take place may lower its incidence and decrease EDs visits.

The Brazilian Amazon is home to a rich fauna of scorpion species of medical importance, some of them still poorly characterized regarding their biological actions and range of clinical symptoms after envenoming. The Amazonian scorpion species Tityus strandi and Tityus dinizi constitute some of the scorpions in this group, with few studies in the literature regarding their systemic repercussions. In the present study, we characterized the clinical, inflammatory, and histopathological manifestations of T. strandi and T. dinizi envenoming in a murine model using Balb/c mice. The results show a robust clinical response based on clinical score, hyperglycemia, leukocytosis, increased cytokines, and histopathological changes in the kidneys and lungs. Tityus strandi envenomed mice presented more prominent clinical manifestations when compared to Tityus dinizi, pointing to the relevance of this species in the medical scenario, with both species inducing hyperglycemia, leukocytosis, increased cytokine production in the peritoneal lavage, increased inflammatory infiltrate in the lungs, and acute tubular necrosis after T. strandi envenoming. The results presented in this research can help to understand the systemic manifestations of scorpion accidents in humans caused by the target species of the study and point out therapeutic strategies in cases of scorpionism in remote regions of the Amazon., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Understanding animal's behaviour and adaptation in the face of threats and predators under different biotic and abiotic conditions is fundamental in ecology. In this study we examined defensive behaviour of Buthus atlantis scorpion in order to assess how various factors such as temperature, prey type, and threatening conditions influence stinging behaviour, venom usage and regeneration. Our study had revealed that stings frequency was significantly lower in cooler temperature compared to the medium and warm temperature. Threatening condition had no significant effect in medium and warmer temperature, the difference between the two conditions was only significant in the cooler temperature. Conversely, we had shown that venom expenditure in B. atlantis is regulated by both temperature and threatening conditions. Our results show that scorpions maintained in higher temperatures yielded the greatest amount of venom compared to those in lower temperatures. Analyses of proteins concentration according to temperature and diet variation had revealed that scorpions placed in intermediate (25 °C) and warmer temperature (40 °C) had a significantly higher venom proteins concentration when compared to the cooler temperature (10 °C). Results also showed that scorpions adjust their venom usage based on their perception of danger, which can be influenced by temperature., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background Scorpion envenoming is relatively frequent in tropical and subtropical regions and potentially fatal. We aimed to identify risk factors for fatal scorpion envenoming among Brazilian children. Methods A case–control study investigated all fatal cases of scorpion envenoming among children up to 10 y old, reported to the Brazilian Diseases Surveillance System between 1 January 2007 and 18 July 2016. Controls were randomly sampled from children who survived the envenoming over this period. Data were analysed using logistic regression. Results Of the 254 cases and 1083 controls investigated, the identified risk factors were age ≤5 y, occurred in a rural area, time-to-treatment ≥3 h, treatment with scorpion antivenom (SAV) but either excessive or insufficient number of vials, treatment with antivenom that was neither SAV nor anti-spider and no antivenom administered compared with the standard recommended treatment. Treatment effectiveness at preventing fatal scorpion envenoming was 77.0% when time-to-treatment was <3 h and 75% in children 9–10 y of age. SAV was 63% effective at preventing death when administered early at the recommended dosage. Conclusions Fatal scorpion envenoming was associated with younger age, incident occurring in a rural area, late treatment and inadequate antivenom treatment. SAV was effective at preventing death when administered early. [ABSTRACT FROM AUTHOR]

Sixty-seven scorpion species have been described in France and its territories, where they have been found to be heterogeneously distributed. Indeed, only one species can be found on Réunion Island, while 38 species exist in French Guiana. The number of stings is also heterogenous, with up to 90 stings per 100,000 inhabitants occurring annually. Scorpion species can frequently be determined through simple visual factors, including species of medical importance (i.e., Buthus, Centruroides and Tityus). Scorpion venom is composed of local enzymes and peptides with a cysteine-stabilized α/β motif (NaTxs, Ktxs, Calcines), which allow for venom diffusion and the prey’s incapacitation, respectively. Harmful scorpion species are limited to Centruroides pococki in the French West Indies, which can induce severe envenoming, and the Tityus obscurus and Tityus silvestris in French Guiana, which can cause fatalities in children and can induce severe envenoming, respectively. Envenomation by one of these scorpions requires hospital monitoring as long as systemic symptoms persist. Typical management includes the use of a lidocaine patch, pain killers, and local antiseptic. In the case of heart failure, the use of dobutamine can improve survival, and pregnant women must consult an obstetrician because of the elevated risk of preterm birth or stillbirth. France does not have scorpion antivenom, as scorpion stings are generally not fatal.

Abstract Background: Although scorpionism is recorded worldwide, some regions such as Iran present a higher incidence. Due to the great prevalence of scorpion stings in Khuzestan province, southwestern Iran, the present study examined the relationship between different climate parameters and the scorpion sting rate in this area from April 2010 to March 2015. Methods: In this cross-sectional descriptive-analytical study, we considered all scorpion sting cases recorded in the Department of Infectious Diseases, Ahvaz Jundishapur University of Medical Sciences. Data were analyzed using statistics, frequency distribution and Pearson’s correlation coefficient. Results: A total of 104,197 cases of scorpion stings was recorded from 2010 to 2015. The cumulative incidence of scorpion sting was 2.23%. The spatial distribution of scorpion stings showed that most cases occurred in the Dehdez district (4,504 scorpion stings/100,000 inhabitants) and the Masjed Soleyman county (4,069 scorpion stings/100,000 inhabitants). A significant association was found between climate factors (temperature, evaporation rate, sunshine duration, humidity, and precipitation) and the scorpion sting rate. An increase in rainfall and humidity coincided with a reduction in scorpion stings whereas an increase in temperature, evaporation, and sunshine duration was accompanied by a growth of scorpion stings. No significant correlation was found between wind velocity/direction and the incidence rate of stings. Moreover, the seasonal peak incidence of scorpion stings was recorded in summer (an average of 8,838 cases) and the lowest incidence was recorded during winter (an average of 1,286 cases). The annual trend of scorpion sting cases decreased during the period from 2010 to 2015. Conclusion: Climate variables can be a good index for predicting the incidence of scorpion stings in endemic regions. Since they occur mostly in the hot season, designing preventive measures in the counties and districts with a high incidence of scorpion stings such as Dehdez and Masjed Soleyman can minimize mortality and other burdens.

Background: Arizona's rugged desert landscape harbors many venomous animals, including a small nocturnal scorpion, Centruroides sculpturatus, whose venom can cause severe neuromotor disturbance. An effective antivenom is available at selected health care facilities in the state.Methods: We analyzed 4398 calls of scorpion stings to the Arizona Poison and Drug Information Center (APDIC) in Tucson over a period of 3 years, from January 2017 to December 2019.Results: We followed 1952 (44.4%) of the victims to resolution. We excluded 2253 callers with minimal effects of the sting and 193 victims with possible toxic effects who were lost to follow-up. The most common complaints among callers were pain at the sting site in 88.9% and local numbness in 62.2%. Detailed clinical information was obtained from 593 calls from a health care facility. Neuromotor signs consistent with C. sculpuratus envenomation included nystagmus in 163 (27.5%), hypersalivation in 91 (15.3%), and fasciculations in 88 (14.8%). Antivenom (Anascorp; Rare Disease Therapeutics, Inc., Franklin, Tenn) was administered to 145 patients. Most were children <5 years old (n = 76, or 54.4%); 27 (18.6%) were 5-9 years old and 42 (30.0%) were ≥10 years of age. About half, 79 of 145 (54.5%) victims who received antivenom, met the APDIC recommended use criteria.Conclusions: Patients treated with antivenom exhibited a rapid resolution of symptoms without immediate or delayed hypersensitivity reactions. We recommend broadened availability of antivenom at sites where it is most needed. [ABSTRACT FROM AUTHOR]

Hemiscorpius lepturus of Hemiscorpiidae is the most dangerous scorpion in Iran. In the current study, habitats of this species and morphological characters of specimens were considered in both regions of Ahvaz and Ramhormoz. [ABSTRACT FROM AUTHOR]

Objectives: We sought to review the management of scorpion stings in tertiary and secondary care emergency departments in Oman and determine physician’s knowledge of management protocols. Methods: We conducted a retrospective study of all scorpion stings cases seen in Sultan Qaboos University Hospital (SQUH) emergency department (ED) from March 2016 to July 2017. Additionally, we conducted a survey of ED physicians regarding their management of scorpion stings in three different EDs including SQUH. Results: The total number of scorpion stings seen at SQUH during the study period was 128. Localized pain was seen in 97.7% (n = 125), swelling in 14.8% (n = 19), and local redness in 7.0% (n = 9) of patients. Around 13.0% (n = 17) of patients were found to have systemic symptoms with tachycardia being the most common. Bedside clotting test was done for 11.7% (n = 15) of patients. The most commonly used treatment was local anesthesia (54.7%, n = 70). No patient received scorpion antivenom. In the 89 surveyed physicians the main management method used was analgesia (88.8%, n = 71) followed by local anesthesia (81.1%, n = 65). Most physicians (80.0%, n = 64) believed that local anesthesia was the most effective management. However, 32.5% (n = 26) ordered a whole blood bedside clotting test, 69.2% (n = 18) of which were junior doctors. Conclusions: Most scorpion sting cases managed in SQUH had local symptoms. Tachycardia was the most common systemic manifestation. Bedside clotting test was not commonly ordered and mainly requested by junior doctors. Local anesthesia infiltration is the recommended management for scorpion sting. Analgesia was the main management followed by local anesthesia.

The twelve Arab countries of the Middle East are inhabited by 117 species of scorpions of varying medical importance within six families. Scorpion stings are a very common occurrence throughout the region. Twenty-two scorpion species are considered to be dangerously venomous, causing potentially life threatening stings. Accessible literature in English and Arabic on scorpions, scorpion stings and available antivenoms was reviewed to document the scorpion fauna and scorpion stings in each country. Saudi Arabia, Iraq and Jordan report the highest numbers of stings and envenomings. Clinically, the most important toxins in Old World scorpion venoms are α-toxins that target voltage-gated sodium (Na v) channels at neurotoxin binding site 3, causing sympathetic excitation and the endogenous release of catecholamines that is responsible for transient, but life-threatening myocardial damage. Most victims of scorpion stings suffer severe local pain, but a few, especially children, develop systemic envenoming which, in the case of most Middle Eastern buthid species, such as Androctonus and Leiurus species, is dominated by the cardiovascular and respiratory consequences of hypercatecholinaemic myocarditis. Other syndromes include paralysis (Parabuthus leiosoma), coagulopathy (Nebo hierichonticus and Hemiscorpius species), and local tissue damage, haemolysis and acute kidney injury (H. lepturus). Early antivenom treatment is recommended but its value remains controversial. However, intensive care, with the ancillary use of vasoactive drugs such as prazosin and dobutamine, has proved effective. Image 1 • The taxonomy and occurrence of medically important scorpion species in each Arab country in the Middle East is reviewed. • Epidemiology and clinical features of envenoming by dangerous species are described. • Based on current practice, use of antivenoms and ancillary treatments in Arab countries in the Middle East is discussed. [ABSTRACT FROM AUTHOR]

In 2018 Scorpion Sting Envenomation (SSE) in Mexico occurred 19,966 times in children under 5 years of age. In Sonora, the Centruroides sculpturatus sting causes neuromotor excitation syndrome that requires specific antiven. The objective of this work was to describe the ABSTRACT In 2018 Scorpion Sting Envenomation (SSE) in Mexico occurred 19,966 times in children under 5 years of age. In Sonora, the Centruroides sculpturatus sting causes neuromotor excitation syndrome that requires specific antiven. The objective of this work was to describe the clinical characteristics and treatment of the outpatient in children with SSE at the Hospital Infantil del Estado de Sonora (HIES) from 2017 to 2018. The clinical notes of the Emergency Service of the children who were treated during that period with SSE and, without serious or hospitalized intoxication. Epidemiological and clinical variables were analyzed in children under 18 years old; with the information obtained, a descriptive analysis was carried out by mean, standard deviation and frequency and percentage. The 279 cases were analyzed, school-age children were the most affected (41.2%), and 55.8% presented mild intoxication SSE. Pain was observed in 65.9% and the 72.6% of the children, they received at least one vial of drug therapy and 55.9% of the boys with mild SSE only received one vial with satisfactory results. None of the children who received drug therapy presented adverse events or required hospitalization, only one child received six vials and the administration of the drug in less than 4 hours decreased the percentage of children with serious neurotoxic effects. [ABSTRACT FROM AUTHOR]

Introduction: Scorpionism is a public health problem, especially in tropical regions. In Brazil, the prevalence of envenomation by scorpions is high, and the average national lethality is around 0.16 percent. The Tityus serrulatus scorpion is the primary species of medical importance. However, objective tools to predict and define the severity of these envenomations are lacking., Materials and Methods: This was an observational study conducted among patients aged 0-19 years with scorpionism. Patients were admitted to a reference hospital between December 2020 and May 2022. Point-of-care ultrasound was performed within 24 hours of the scorpion sting., Results: Forty-nine patients were included, with a median age of 3.6 (interquartile range 2.3-5.3) years and a predominance of females (51 percent). Fifteen patients (30.6 percent) presented major life-threatening signs, 32 (65.3 percent) minor systemic manifestations, and two (4.1 percent) only local manifestations. Left ventricular dysfunction was identified in 13 patients (26.5 percent). Ten patients (20.4 percent) presented pattern B (visualization of three or more B lines in the evaluated quadrant) in at least one lung window. The sensitivity and specificity of cardiac and pulmonary ultrasound to identify the most severely ill patients were 86 percent and 94 percent, respectively., Discussion: The changes found on point-of-care ultrasound were associated with life-threatening signs. All patients with class III envenomation were referred to the intensive care unit, showing the importance of early identification of this subgroup. The main limitations were the small sample size and the fact that admission to intensive care was not based on systematic criteria., Conclusions: Point-of-care ultrasound is able to identify early signs of pulmonary congestion and heart failure in scorpionism. It can be useful for the objective selection of patients who are at a higher risk of complications and death and who require intensive support; it may also be valuable for periodic reassessments. Point-of-care ultrasound is a valuable tool for identifying and monitoring severe cases of scorpionism.

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.

OBJECTIVES This study was conducted to provide better insights into the demographic and epidemiological characteristics of scorpion envenomation in an endemic area in Algeria and to identify the model that best predicted daily scorpion sting counts. METHODS Daily sting data from January 1, 2013 to August 31, 2016 were extracted from questionnaires designed to elicit information on scorpion stings from the two emergency medical service providers in Touggourt, Algeria. Count regression models were applied to the daily sting data. RESULTS A total of 4,712 scorpion sting cases were documented, of which 70% occurred in people aged between 10 years and 49 years. The male-to-female ratio was 1.3. The upper and lower limbs were the most common locations of scorpion stings (90.4% of cases). Most stings (92.8%) were mild. The percent of people stung inside dwellings was 68.8%. The hourly distribution of stings showed a peak between 10:00 a.m. and 11:00 a.m. The daily number of stings ranged from 0 to 24. The occurrence of stings was highest on Sundays. The incidence of scorpion stings increased sharply in the summer. The mean annual incidence rate was 542 cases per 100,000 inhabitants. The fitted count regression models showed that a negative binomial hurdle model was appropriate for forecasting daily stings in terms of temperature and relative humidity, and the fitted data agreed considerably with the actual data. CONCLUSIONS This study showed that daily scorpion sting data provided meaningful insights; and the negative binomial Hurdle model was preferable for predicting daily scorpion sting counts.

In Mexico, especially in certain regions, there are frequent cases of scorpion sting (from the ar., Al-'aqrab, the scorpion) and scorpionism; although the clinical presentation is known, empirical treatment is highly variable, and there are some controversial medical therapies. It is prudent that general practitioners and doctors of any specialty have notions about this health problem. [ABSTRACT FROM AUTHOR]

The main aim of this study is to estimate the economic burden and prevalence of bites and stings injuries in Saudi Arabia. A retrospective, cross-sectional study was conducted at King Saud University Medical City (KSUMC) for all bites and stings cases presented to the Emergency Department (ED) between the period June 2015 and May 2019. A total of 1328 bites and stings cases were treated in the ED at KSUMC. There were 886 insect bites and stings cases, 376 animal bites, 22 human bites, 34 scorpion stings, and ten snakebites. Most cases were reported in April - June. Females account for 62% of the reported cases, and the mean age was 24 years old. The total management cost of bite and sting cases during the study period was 3.4 million Saudi Riyal (SR). The spending cost of the management of animal bites was the highest as it cost 1,681,920.76 SR, followed by insect's management costing 1,228,623.68 SR. Bites and stings have a considerable health care burden on our society. Although the vast majority of the cases were not associated with a severe life-threatening condition, many were visit ED and associated with high medical costs. Increased awareness of the hazards of animal-related injuries, especially during spring and summer, where most cases take place may lower its incidence and decrease EDs visits. [ABSTRACT FROM AUTHOR]

Introduction. Scorpion stings are a matter of medical importance in Mexico; The objective was to evaluate the analgesic efficacy of lysine, ketorolac and sodium metamizol clonixinate, using an analog visual pain scale (VAS) in scorpion poisonings. Methods. Randomized and controlled clinical trial, from May 6, 2019 to July 14, 2019, 4 treatments were administered intravenously: placebo, ketorolac, sodium metamizole and lysine clonixinate. We evaluate VAS at 0, 30, 60, 90 minutes and 18 hours after treatment. Results. 160 patients were analyzed. At 18 hours the visual analog pain scale was 0 (0-0) for placebo; Ketorolac 0 (0-0); Lysine clonixinate 0 (0-1) and sodium metamizole 0 (0-0) p = 0.221. Conclusions. Nonsteroidal anti-inflammatory analgesics in an acute scorpion sting event have no greater effect than placebo use. [ABSTRACT FROM AUTHOR]

Scorpionism has a high incidence rate in Brazil. It is considered a serious public health problem mainly in tropical and subtropical regions around the world. The number of scorpion accidents have increased over the years and the highest frequencies have been reported mainly in the Brazilian Northeast region. Therefore, in this study we report a retrospective clinical and epidemiological analysis of scorpion stings from 2007 to 2017 in Alagoas State, Northeast Brazil, at a referral hospital for assistance and treatment of accidents by venomous animals. During the analyzed period, the referral hospital treated 27,988 cases, and an increase in the number of cases has taken place over the years. The highest frequency of scorpion stings was observed in females, and the age range most affected was from 20 to 29 years old. The most stung body site was the foot, followed by finger, toe or hand. Regarding the severity, most severe cases were reported in children up to 4 years old (69.4%) and 50% of the total cases treated with serotherapy corresponded to patients in this age range. Interestingly, it was also found that the occurrence of systemic manifestations and the severity of the cases were significantly associated with pediatric patients. In this way, this study highlights the scorpionism as an environmental public health problem in Alagoas State, Northeast Brazil, as well as the need to intensify the epidemiological surveillance and educational campaigns to prevent and control scorpion accidents throughout the year. [ABSTRACT FROM AUTHOR]