Toxicological and epidemiological studies of scorpion sting cases and morphological characterization of scorpions (Leiurusquin questriatus and Androctonus crassicauda) in Luxor, Egypt

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

BACKGROUND

Snakebite envenomation (SBE) and scorpion sting envenomation (SSE) are significant neglected tropical diseases that primarily affect impoverished communities in rural areas of developing nations. A lack of understanding about snake and scorpion species and their distribution exacerbates the disabilities and fatalities caused by SBE and SSE. In Sudan, particularly in regions affected by ongoing conflicts where healthcare resources are scarce, social media platforms offer a cost-effective approach to addressing public health challenges. Our aim in this study is to highlight the benefits of using social media for data collection and health promotion in such environments.

METHODS

We present a cost-effective communication and data collection strategy implemented at the Toxic Organisms Research Centre (TORC) of the University of Khartoum, focusing on a Facebook group, "Scorpions and Snakes of Sudan", as our primary social media platform. Additionally, we discuss the lessons learned and the initial impact of this strategy on enhancing population health literacy.

RESULTS

The group community is composed of ~ 5000 members from 14 countries. During the period from January 2023 to January 2024, we received 417 enquiries about snakes and scorpions belonging to 11 families and composed of 55 species. In addition, 53 other enquiries covered a range of organisms and their tracks (e.g., spiders, skinks, chameleons, foxes, sun spiders, centipedes, lizards, moth larvae, and insect tracks). The first photographic evidence of Malpolon monspessulanus in Sudan was via the group activities. The rare species Telescopus gezirae, the Blue Nile cat snake, is also documented via the group member's queries. Recognizing the evolving nature of social media use in public health, we also address the current limitations and evidence gaps that need to be addressed to effectively translate best practices into policy.

CONCLUSION

In conclusion, utilizing Facebook as an institutional platform to share scientific information in simple Arabic language underscores the proactive roles that citizens, scientists, and public health stakeholders can play in leveraging social media for eHealth, eAwareness, and public health initiatives. This approach highlights the potential for collaborative efforts, particularly during crises, to maximize the benefits of social media in advancing public health.

When Venom Meets the Heart: A Rare Case of Scorpion Sting-Induced Acute Myocardial Infarction

Scorpion sting cases are everyday encounters in the Emergency Department (ED). However, scorpion sting-induced systemic manifestations are rarely seen. Signs and symptoms of envenomation involve the central nervous system, stimulation of the autonomic nervous system and rarely respiratory and heart failure leading to death. Cardiovascular manifestations are particularly prominent following stings by the Indian red scorpion. This case report is of an 18-year-old male patient who presented to ED with complaints of scorpion sting. Twelve lead electrocardiography (ECG) done was suggestive of acute inferior wall myocardial infarction with raised cardiac markers. He also had autonomic dysfunction in the form of hypertension, hypothermia and priapism. He was treated with an alpha-blocker, dual antiplatelets and analgesics. ECG changes reverted to normal the next day, and he was discharged. So, the anticipation of life-threatening complications of scorpion stings plays a vital role in the treatment and prognosis of patients presenting to ED.

Toxicity Mechanism of Dangerous Scorpion Stings in Iran

Background

Considering the importance of scorpions and recognizing the mechanisms of toxicity caused by their medically important species in Iran and adopting the best therapeutic approach based on these mechanisms, this study was performed by reviewing the clinical manifestations of scorpion stings.

Methods

The research was conducted by searching for articles and researches in related websites (PubMed, EMBASE, Scopus, Web of Science and CINAHL) and using domestic and international authoritative journals using the keywords of scorpion, clinical manifestations, in a review method. Finally, 104 qualified sources were selected and after reviewing and criticizing these studies, the author's point of view was presented.

Results

Clinical manifestations of Scorpion sting toxicity vary due to the existence of two toxic classes of neurotoxins and cytotoxins or hemotoxins in these arthropods in Iran. The number and distribution of species with neurotoxic venom are higher than the scorpions with cytotoxic venom and are reported throughout Iran. Scorpions with cytotoxic venom are mostly widespread in south and southwest of Iran.

Conclusion

Treatment and prevention of scorpion stings in Iran and neighboring countries in the Middle East should be planned based on the mechanism of toxicity and the presence of toxic classes with neurotoxic or cytotoxic venoms.

Ethnomedicines for the treatment of scorpion stings: A perspective study

ETHNOPHARMACOLOGICAL RELEVANCE

Scorpion sting is a public health concern with limited clinical symptomatic treatment. The clinical treatment uses anti-scorpion antivenom and prazosin (α-adrenergic inhibitor), often in combination with insulin, to reduce scorpion venom-induced hyperglycemia and other complications. However, these therapies also possess some limitations, necessitating urgent exploration of ethnomedicines, mainly traditional medicinal plants, to treat scorpion stings. Unfortunately, several conventional treatments are not scientifically validated, thus raising questions about their quality and utility. Therefore, pharmacological re-assessment of such medicinal plants to alleviate scorpion stings' complications is essential.

AIM OF THE STUDY

The principal objectives of this study are to provide a brief overview of medically important scorpions of the world, outline the extant traditional practices, and comprehensively review plants used in conventional ethnic medicines to treat scorpion stings over time. Modern technological advances in identifying and characterizing plant bioactive molecules are also mentioned in this review.

MATERIALS AND METHODS

The traditionally used medicinal plants against scorpion stings were reviewed from the available literature in the database. The Plant List (http://www.theplantlist.org/) was used to validate the scientific names of the plants mentioned in this study. The search targeted literature on conventional treatments and crude plant extracts or their bioactive components with proven neutralization capacity against scorpion stings. Search words used were 'scorpion sting,' 'treatment for a scorpion sting,' 'antivenom and scorpion sting,' 'traditional treatment for scorpion stings, and 'natural compounds against scorpion stings'.

RESULTS

A list of more than 200 medicinal plants traditionally used in several countries for treating scorpion stings is presented in this review. Though some myth-based remedies are practiced to treat scorpion stings, no empirical evidence exists to validate this aspect of traditional knowledge. Only 38 traditional medicinal plant extracts have been tested under in-vivo and in-vitro conditions to determine their neutralization potency of scorpion envenomation. Although a few bioactive plant constituents showing scorpion venom neutralization potency have been characterized, they are not yet commercially available for clinical application.

CONCLUSIONS

There is tremendous potential locked in medicinal plants' traditional knowledge for scorpion envenomation treatment. Translating this knowledge into the clinical application will require pharmacological reassessment, in tandem with isolation and characterization of active compounds to prove their prophylactic prowess. Almost equally important would be the formulation of stringent strategies to conserve such medicinal plants from overexploitation.

EFFECT OF SCORPION VENOM TOXINS ON STRUCTURAL AND FUNCTIONAL PARAMETERS OF INTERNAL ORGANS, INCLUDING KIDNEYS (REVIEW)

OBJECTIVE

The aim: To establish patterns of structural and functional changes in internal organs, including kidneys, under the conditions of exposure to scorpion venom toxins.

PATIENTS AND METHODS

Materials and methods: A thorough literature analysis was conducted on the basis of PubMed, Google Scholar, Web of Science, and Scopus databases. When processing the search results, we chose the newest publications up to 5 years old or the most thorough publications that vividly described the essence of our topic.

CONCLUSION

Conclusions: The venom of various species of scorpions exhibits a wide range of biological activity. Acting on the structures of the central and peripheral nervous system, the toxins of scorpion venom cause the development of paralysis, convulsions, brain inflammation, hemorrhagic and ischemic strokes. Under conditions of influence on the cardiovascular system, damage to the endothelial lining of the vascular wall, disturbances in heart rhythm, conduction, and the development of destructive changes in the myocardium are characteristic. Data on kidney damage due to scorpion bites require a more detailed study, as information on microscopic and submicroscopic changes in the structure of the organ is too limited. However, cases of the development of tubular necrosis, interstitial nephritis, and kidney infarction are currently known.

Predictive Value of Glycemia and Free Fatty Acid Levels upon Admission of Children with Scorpionism in Egypt

Scorpion envenomation is a life-threatening emergency and causes serious health problems in tropical and subtropical regions. The aim of this study was to correlate the serum levels of biochemical parameters at admission in children with scorpion envenomation with subsequent morbidity and mortality. It was a prospective, observational, and descriptive study conducted for scorpion-envenomed children who presented to emergency and intensive care units between April 2019 and September 2019. Demographic, clinical, and laboratory findings of patients were recorded and tabulated. Routine investigations were done for all patients in addition to blood levels of lactate, free fatty acids (FFA), and insulin. All patients were compared according to outcome as survivors and nonsurvivors and according to glucose level as normoglycemic and hyperglycemic groups. There were 62 scorpion sting cases; their mean age was 8.6 ± 3.2 years. Patients aged more than 6 years (74.2%), and males (66.1%) were more affected than others. As regards severity, 25.8% were suffering organ dysfunction, 40.3% suffered systemic manifestations without organ dysfunction, and (33.9%) with only local manifestations. Serum glucose and FFA were significantly higher in nonsurvivors compared with survivors. Shock, convulsion, coma, heart failure, and pulmonary edema were significantly more common in hyperglycemic than normoglycemic group. Hyperglycemia, and raised FFA were associated with severe scorpion envenomation. Raised FFA was well correlated with presence of heart failure, leucocytosis, and hyperglycemia. Adding serum glucose and FFA to monitoring parameters of scorpionism severity can help the prediction of high-risk patients.

Evaluation of Human Wharton's Jelly-Derived Mesenchymal Stem Cells Conditioning Medium (hWJ-MSCs-CM) or Scorpion Venom Breast Cancer Cell Line In Vitro

PURPOSE

The present study aimed to evaluate the anticancer potential of Egyptian scorpion Leiurus quinquestriatus venom (ScV) or human Wharton's jelly-derived mesenchymal stem cells conditioning medium (hWJ-MSCs-CM)/CM against breast cancer (MCF-7) cell line as an alternative effective cancer biotherapy.

METHODS

Venom (ScV) toxicity was performed recording concentration-dependent viability % and ScV IC₅₀ value was in the order of 100 μg/ml. MCF-7 were treated with hWJ-MSCs-CM used as (25%, 50%, and 75% ml) or the IC₅₀ of ScV. Apoptotic activity was traced via evaluation the apoptotic (Bax, Casp-3, and Casp-9) and anti-apoptotic genes (Bcl2, ALDOA, and PKM2) profile.

RESULTS

Both Bax and Casp-3 showed a significant upregulation while anti-apoptotic genes were significantly downregulated. In the meantime, Casp-3 and Casp-9 protein were monitored using ELISA, and their level was less than in control. Additionally, MCF-7 apoptosis was monitored using flow cytometry recording a significant DNA accumulation in the G0-G1 and S phases in case of cell treatment with ScV or CM75% ml and 50% ml. Also, there was a significant total necrotic cells % compared with control cells, and total apoptosis under the effect of ScV or CM75% ml was significantly elevated than rest of treatment.

CONCLUSION

Apoptosis induction was both dose- and time-dependent for hWJ-MSCs-CM and ScV. According to the present study and other studies, there is an ample evidence that hWJ-MSCs-CM and the venom IC₅₀ abolish tumor growth.

Terrestrial venomous animals, the envenomings they cause, and treatment perspectives in the Middle East and North Africa

The Middle East and Northern Africa, collectively known as the MENA region, are inhabited by a plethora of venomous animals that cause up to 420,000 bites and stings each year. To understand the resultant health burden and the key variables affecting it, this review describes the epidemiology of snake, scorpion, and spider envenomings primarily based on heterogenous hospital data in the MENA region and the pathologies associated with their venoms. In addition, we discuss the venom composition and the key medically relevant toxins of these venomous animals, and, finally, the antivenoms that are currently in use to counteract them. Unlike Asia and sub-Saharan Africa, scorpion stings are significantly more common (approximately 350,000 cases/year) than snakebites (approximately 70,000 cases/year) and present the most significant contributor to the overall health burden of envenomings, with spider bites being negligible. However, this review also indicates that there is a substantial lack of high-quality envenoming data available for the MENA region, rendering many of these estimates speculative. Our understanding of the venoms and the toxins they contain is also incomplete, but already presents clear trends. For instance, the majority of snake venoms contain snake venom metalloproteinases, while sodium channel-binding toxins and potassium channel-binding toxins are the scorpion toxins that cause most health-related challenges. There also currently exist a plethora of antivenoms, yet only few are clinically validated, and their high cost and limited availability present a substantial health challenge. Yet, some of the insights presented in this review might help direct future research and policy efforts toward the appropriate prioritization of efforts and aid the development of future therapeutic solutions, such as next-generation antivenoms.

Scorpion Stings in Saudi Arabia: An Overview

Background and aim of the work:

Scorpion sting envenomation is an important cause of morbidity and mortality among incidents caused by envenomations, especially in children and elderly, worldwide. In Saudi Arabia, it is an important issue as the climate and the desert terrain are ideal for scorpions’ habitat. The aim of this review is to emphasize on the importance of scorpion stings in Saudi Arabia and provide updates regarding scorpion types and epidemiological aspects of scorpion stings in Saudi Arabia.

Methods:

Aliterature review of articles on scorpions and scorpion stings in Saudi Arabia.

Results:

In Saudi Arabia, at least 28 species of scorpions are identified. An estimated 14,500 scorpion stings are annually documented in various regions of Saudi Arabia. Most of the cases of scorpion envenomation recover completely with treatment in Saudi Arabia. People who live in the desert terrain, such as nomads or shepherds, are the population at highest risk for scorpion stings. The highest incidence of scorpion stings is reported during the summer season.

Conclusion:

Scorpions are found to inhabit all the regions of the country. The incidence of scorpion stings in Saudi Arabia seems to be significant. However, the mortality rate is low in Saudi Arabia. There are insufficient studies regarding this topic, and as such, it is clear that there is a lack of information regarding autopsy findings of scorpion sting deaths in Saudi Arabia. (www.actabiomedica.it)

Echocardiographic Evaluation of the Response to Prazosin Treatment in Scorpion Sting

BACKGROUND

Scorpion envenomation is a major public health problem in children that can induce lethal neurological, respiratory and cardiovascular complications. We aimed to evaluate cardiovascular complications with a follow-up of envenomed children for 1 month for possibility of incomplete recovery.

METHODS

This was a prospective study conducted for children who presented with scorpion sting to Emergency and Intensive Care units. Demographic, clinical and laboratory findings of patients were recorded. Cases with suspected clinical and electrocardiographic manifestations of myocarditis were subjected to bedside echocardiography with follow-up at the end of the first week and the first month.

RESULTS

Scorpion sting cases presented to our hospital were 81 cases during 1-year study; of them, 17 cases were stable without systemic manifestations after 12 h observation and discharged. Sixty-four cases suffered systemic organic complications and needed ICU admission; their mean age was 11.52 ± 3.74 and 64% of them were males. Twenty-eight of admitted cases showed manifestations of myocarditis and by echocardiography, all of them had evidence of left ventricular dysfunction. On follow-up, there was significant improvement at the end of first week and complete improvement at the end of first month except three cases who died due to pulmonary edema and cardiogenic shock.

CONCLUSION

Acute toxic myocarditis is a common and an important cause of morbidity and mortality following scorpion envenomation that necessitates early and aggressive management. High index of suspicion, serial electrocardiogram monitoring and echocardiography are three integrative lines required to recognize this serious complication. Lay summaryAcute toxic myocarditis is a common cause of morbidity and mortality following scorpion envenomation that necessitates rapid medical treatment. We aimed to evaluate cardiovascular complications after scorpion sting with a follow-up of envenomed children for 1 month for possibility of incomplete recovery. Tachycardia was the most frequent observed cardiac sign followed by hypotension, while the least was bradycardia and hypertension. All cases with manifestations suggestive of myocarditis were evaluated by bedside two-dimensional echocardiography and showed evidence of left ventricular dysfunction, that begin to regress within 1 week of treatment unless progressive pulmonary edema and resistant cardiogenic shock occurred. On follow-up for survivors, complete improvement at the end of first month was noticed. Clinical suspicion, serial ECG monitoring and echocardiography are required for rapid and early diagnosis. Early use of prazosin therapy can prevent long-term residual damage as evidenced by echocardiographic evaluation.

Effects of climate variables on the incidence of scorpion stings in Iran for five years

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.

Toxicology and snakes in ptolemaic Egyptian dynasty: The suicide of Cleopatra

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Cleopatra a paradigmatic case of femenine power, personal charm and cold courage.

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Ptolemaic Dynasty, especially the last queen, was interested in drugs and poisons.

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The snake theory prevailed about her death, however, that is quite problematic.

The decadent Lagids’dynasty was especially interested in drugs and poisons meanwhile Alexandria became a prestigious center of learning and the first medical center of the ancient world. Scholars dedicated to toxicology would research in the famous Museion and the Hellenistic rulers of Alexandria and other kingdoms had court physicians specialized in pharmacology and venoms. As the last member of Ptolemaic Dynasty, Cleopatra VII inherited the throne and also the great inclination of Ptolemies towards medicine and science. In this city toxicological education seems to have had its most systematic development, and for Galen [1] “human and prompt executions’ were made in Alexandria with the intervention of cobras”.

Attracted by the knowledge of venoms and poison, Cleopatra began to test them on condemned prisoners to see the different reactions produced in the body and found toxic limits. When she decided to commit suicide, the use of poison would make sense given the possibility to choose the best one to get a quick and relatively pain free death. Knowing that oral poisons would cause disturbances as painful spasms, nauseas, abdominal cramps and slow end, she presumably compared the major effects of venemous snakebites caused by the various species living in Egypt, specially three families: vipers, hydrophids and elapids.

Cleopatra probably realized that viper bites generally produce violent local pain with inflammation, oedema, skin discoloration, pustules, vomiting and blood loss. With the cobra venom, hemotoxic or neurotoxic, instead, death could happen within half an hour, by respiratory failure and general paralysis without leaving any trace on the flesh, though. It has been said that Cleopatra used the cobra to kill herself because it would also make sense in terms of Egyptian mythology, being associated with the sacred uraeus worn by the pharaohs. However, there are several problems with this theory and some scholars recently argue it’s more likely she would drank a cocktail of drugs or applied a toxic ointment, as Strabo suggested.

Studying the different poisons and the snakes that she could have selected and the symptoms and consequences that they could produce in her body, we’ll try to delve into her possible lucubrations and reflexions, weighing the difficulties in each case. Undoubtedly, the mysterious end of Cleopatra remains unsolved, offering a constant source of legends and theories. Keeping this in mind we will try to present the pros and cons of each of her possible decisions.

Autopsy Findings in Case of Fatal Scorpion Sting: A Systematic Review of the Literature

Scorpion sting is a public health issue in several countries, particularly in America, the Middle East, India and Africa. The estimated annual global incidence of scorpion envenomings is about 1.5 million, resulting in 2600 deaths. Scorpions are Arthropoda characterized by a tail ending in a terminal bulbous (telson) containing paired venom glands and the stinger. There are 19 known families of scorpions and more than 2200 species, of which about 50 from the families of Buthidae, Hemiscorpiidae and Scorpionidae are harmful to humans. Scorpion venom is a complex structure composed of neurotoxic proteins, salts, acidic proteins and organic compounds, thereby having neurologic, cardiovascular, hematologic and renal side effects, in addition to local effects such as redness, pain, burning and swelling. When the sting is fatal, the mechanism of death is often related to cardiotoxicity with terminal pulmonary edema. However, the cholinergic excess or the neuromuscular excitation can provoke respiratory failure. Sometimes, death is due to an anaphylactic reaction to the envenoming. The purpose of this literature review is to evaluate the autopsy findings in scorpion sting-related deaths in order to better understand the pathophysiological mechanisms underlying them, thus helping pathologists in defining the correct diagnosis.