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Alahyane H, El-Mansoury B, Hakem A, Elmourid A, Ali DA, El Koutbi M, Kaoutar K, El Houate B, Abdelmonaim El Hidan M, Gamrani H, El Khiat A. Assessment of knowledge about first aid methods, diagnosis, and treatment of scorpion stings among health workers in Ouarzazate region, Morocco: A cross-sectional study. Toxicon 2024; 250:108085. [PMID: 39216795 DOI: 10.1016/j.toxicon.2024.108085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 08/08/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
Scorpion envenomation (SE) is a critical and immediate medical emergency. It represents a major public health concern with significant cause of illness and death, particularly in rural regions where scorpions are more prevalent. Of note, administering appropriate first aid to scorpion sting victims is one of the most effective ways to reduce mortality. Therefore, it is crucial to understand the level of knowledge of the healthcare workers in managing such cases. This work aims to assess the levels of knowledge on the diagnosis and management of scorpion stings, as well as the attitudes toward scorpion stings, among doctors and nurses in the Ouarzazate region of Morocco. Our results showed that the prevalent health care age group is 30-39 years, and in terms of experience, the majority had less than 5 years. Additionally, the majority of the participants had no knowledge regarding scorpions' identification. Moreover, only half participants (healthcare workers) received basic training in the management of scorpion stings and almost all of them have not benefited from continuing training. Hence, the current study showed that the understanding of scorpion sting management among healthcare providers in Ouarzazate province is inadequate to ensure proper care for sting patients, and thus including scorpion sting management in the university programs of health care provides along with clinical practice are highly required.
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Affiliation(s)
- Hassan Alahyane
- Higher Institute of Nursing Professions and Health Techniques, Ministry of Health, Beni Mellal, Morocco
| | - Bilal El-Mansoury
- Laboratory of Anthropogenic, Biotechnology and Health, Team Physiopathology Nutritional, Neurosciences and Toxicology, Faculty of Sciences, Chouaib Doukkali University, Av. Des Facultés, 24000, El Jadida, Morocco
| | - Adnane Hakem
- Biological and Health Sciences Team, Higher Institute of Nursing Professions and Health Techniques, Ministry of Health, B.P. 45000, Ouarzazate, Morocco
| | - Abdessamad Elmourid
- Higher Institute of Nursing Professions and Health Techniques, Ministry of Health, Beni Mellal, Morocco.
| | - Driss Ait Ali
- Biological and Health Sciences Team, Higher Institute of Nursing Professions and Health Techniques, Ministry of Health, B.P. 45000, Ouarzazate, Morocco
| | - Mohamed El Koutbi
- Biological and Health Sciences Team, Higher Institute of Nursing Professions and Health Techniques, Ministry of Health, B.P. 45000, Ouarzazate, Morocco
| | - Kamal Kaoutar
- Biological and Health Sciences Team, Higher Institute of Nursing Professions and Health Techniques, Ministry of Health, B.P. 45000, Ouarzazate, Morocco
| | - Brahim El Houate
- Biological and Health Sciences Team, Higher Institute of Nursing Professions and Health Techniques, Ministry of Health, B.P. 45000, Ouarzazate, Morocco
| | - Moulay Abdelmonaim El Hidan
- Laboratory of Biotechnology and Valorization of Natural Resources, Faculty of Applied Sciences, Ibn Zohr University, Morocco
| | - Halima Gamrani
- Laboratory of Clinical and Experimental Neurosciences and Environment, Faculty of Medicine and Pharmacy, Cadi Ayyad University, 40000, Marrakech, Morocco
| | - Abdelaati El Khiat
- Laboratory of Anthropogenic, Biotechnology and Health, Team Physiopathology Nutritional, Neurosciences and Toxicology, Faculty of Sciences, Chouaib Doukkali University, Av. Des Facultés, 24000, El Jadida, Morocco; Biological and Health Sciences Team, Higher Institute of Nursing Professions and Health Techniques, Ministry of Health, B.P. 45000, Ouarzazate, Morocco; Laboratory of Clinical and Experimental Neurosciences and Environment, Faculty of Medicine and Pharmacy, Cadi Ayyad University, 40000, Marrakech, Morocco.
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Darkaoui B, El Hidan MA, Lafnoune A, Arourd D, Belli H, Cadi R, Filali OA, Oukkache N. Epidemiological, clinical, biological and evolutionary profile of scorpion envenomed children under one year to 15 years in the Souss Massa region of Morocco. Toxicon 2024; 247:107832. [PMID: 38945218 DOI: 10.1016/j.toxicon.2024.107832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/02/2024]
Abstract
Morocco is one of the main countries affected in North African with the scorpion envenomations. Faced with the threat, significant morbidity and a major risk of death especially in children, a detailed identification of scorpionic profile of stings remains important for health authorities at national or even regional level. The current study aims to establish the epidemiological, clinical, biological and evolutionary data of the scorpionism by analyzing 383 cases of scorpion stings in children from three age groups (<1 year, 1-5 years and >5 years), admitted at the Regional Hospital Hassan II-Agadir in the Souss Massa region during the period of 9 years and 10 months from January 2013 to October 2022. Our results showed that patients under 1 year of age presented the most severe cases and had the highest mortality rate. However, the clinical signs and symptoms observed illustrated severe damages to vital systems, particularly the cardiovascular, neurological and pulmonary systems, although the signs associated with the latter were present only in cases admitted in grades 2 and 3 for the three age categories studied. Fluctuations in vital constants (temperature and peripheral oxygen saturation, blood pressure, heart rate and respiratory rate), biochemical parameters (ASAT, ALAT, urea and blood creatine, as well as blood sugar) and CBC results revealed major functional disturbances in vital organs, especially in envenomated cases admitted in grade 3. A positive correlation was mentioned between the state of evolution and the various epidemiological parameters, digestive symptoms, as well as signs and symptoms linked to hemodynamic state, general and neurological state. The main interest is to illustrate the seriousness of scorpion envenomations, especially in the high-risk population, for whom an improved therapeutic approach in health centers will undoubtedly be reinforced, and the admission of immunotherapy, as a fundamental part of the treatment, remains important.
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Affiliation(s)
- Bouchra Darkaoui
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, 1 Place Louis Pasteur, Casablanca, 20250, Morocco; Laboratory of Molecular Genetics, Physiopathology and Biotechnology, Faculty of Sciences Ain Chock, Hassan II University of Casablanca, B.P 5366 Maarif, Casablanca, 20000, Morocco.
| | - Moulay Abdelmounaim El Hidan
- Laboratory of Biotechnology and Valorization of Natural Resources, Faculty of Applied Sciences, Ibn Zohr University, Agadir, Morocco
| | - Ayoub Lafnoune
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, 1 Place Louis Pasteur, Casablanca, 20250, Morocco
| | - Driss Arourd
- The Regional Hospital Hassan II, Agadir, 80000, Morocco
| | - Hassan Belli
- The Regional Hospital Hassan II, Agadir, 80000, Morocco
| | - Rachida Cadi
- Laboratory of Molecular Genetics, Physiopathology and Biotechnology, Faculty of Sciences Ain Chock, Hassan II University of Casablanca, B.P 5366 Maarif, Casablanca, 20000, Morocco
| | - Ouafaa Aniq Filali
- Laboratory of Molecular Genetics, Physiopathology and Biotechnology, Faculty of Sciences Ain Chock, Hassan II University of Casablanca, B.P 5366 Maarif, Casablanca, 20000, Morocco
| | - Naoual Oukkache
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, 1 Place Louis Pasteur, Casablanca, 20250, Morocco
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Ben Jemaa A, Bahloul M, Kallel H, Turki O, Dlela M, Bouaziz M. [Inverted Takotsubo Syndrome due to Severe Scorpion Envenomation: Report of one Case]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2021; 1:PWX0-M245. [PMID: 35586636 PMCID: PMC9022762 DOI: 10.48327/pwx0-m245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022]
Abstract
Scorpion envenomation (SE) is common in tropical and subtropical regions. Cardio-respiratory manifestations, mainly cardiogenic shock and pulmonary oedema are the leading causes of death after scorpion envenomation. Cardiac failure can be due to massive release of catecholamines, myocardial damage induced by the venom or myocardial ischemia. Although it has been exceptionally reported, Takotsubo syndrome during SE can help to better elucidate the pathophysiology of this cardiomyopathy. We report a case of inverted Takotsubo following a SE in a 26-year-old patient admitted to the Intensive care unit department for severe scorpion envenomation. His evolution was favorable. We concluded that cardiac involvement in this case fulfills all clinical and paraclinical criteria of Takotsubo syndrome emphasizing the importance of catecholaminergic discharge during scorpion envenomation. We discuss again the management of this syndrome in this specific condition.
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Affiliation(s)
- A. Ben Jemaa
- Département de soins intensifs, Hôpital universitaire Habib Bourguiba, 3029, Sfax, Tunisie
| | - M. Bahloul
- Faculté de Médecine de Sfax. Université de Sfax, Boulevard Majida Boulila, Sfax 3029, Tunisie,*
| | - H. Kallel
- Département de soins intensifs, Hôpital universitaire Habib Bourguiba, 3029, Sfax, Tunisie
| | - O. Turki
- Département de soins intensifs, Hôpital universitaire Habib Bourguiba, 3029, Sfax, Tunisie
| | - M. Dlela
- Département de soins intensifs, Hôpital universitaire Habib Bourguiba, 3029, Sfax, Tunisie
| | - M. Bouaziz
- Département de soins intensifs, Hôpital universitaire Habib Bourguiba, 3029, Sfax, Tunisie
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Nait Mohamed FA, Laraba-Djebari F. Scorpion envenomation: a deadly illness requiring an effective therapy. TOXIN REV 2020. [DOI: 10.1080/15569543.2020.1800746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - Fatima Laraba-Djebari
- USTHB, Faculty of Biological Sciences, Laboratory of Cellular and Molecular Biology, Algiers, Algeria
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Dobutamine in the treatment of severe scorpion envenoming. Toxicon 2020; 182:54-58. [DOI: 10.1016/j.toxicon.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 01/27/2023]
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Involvement of the Endothelin Receptor Type A in the Cardiovascular Inflammatory Response Following Scorpion Envenomation. Toxins (Basel) 2020; 12:toxins12060389. [PMID: 32545475 PMCID: PMC7374423 DOI: 10.3390/toxins12060389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
Elevated levels of endothelin-1 (ET-1) were recorded in sera of scorpion sting patients. However, no studies focused on the mechanism of ET-1 involvement in the pathogenesis of scorpion envenomation, particularly in the cardiovascular system which is seriously affected in severe cases of scorpion stings. Inflammation induced by Androctonus australis hector (Aah) scorpion venom in the heart together with the aorta was studied in mice pretreated with a specific endothelin A receptor (ETA-R) inhibitor. ETA-R inhibition resulted in the attenuation of the high amounts of cytokine (tumor necrosis factor alpha (TNF-α) and interleukin-17 (IL-17)) recorded in the sera of envenomed mice. The recovery of the oxidative stress marker balance and matrix metalloproteinase (MMP) expression were also observed, concomitantly with the reduction of tissular neutrophil infiltration. Additionally, the cardiac and the aortic tissue alterations, and the metabolic enzymes (creatine kinase (CK) and muscle–brain isoform creatine kinase (CK-MB)) overspread into sera were significantly attenuated. Obtained results suggest the implication of endothelin throughout its ETA receptors in the inflammatory response observed in the cardiovascular components during scorpion envenomation. Further knowledge is needed to better understand the implication of the endothelin axis and to improve the therapeutic management of severe scorpion sting cases.
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Abstract
Scorpion envenomation is common in the tropical and subtropical regions. It poses a major public health problem with some patients having serious clinical manifestations and severe complications including death. Old World and New World scorpions are usually contrasted because of differences in venom composition, clinical presentation and severity, and, accordingly, different therapeutic approaches. The majority of scorpion stings are either dry or result in low amounts of injected venom, thus explaining why up to 95% of scorpion stings ensue only in local signs. For a clinical envenomation to occur, it has been suggested that the interaction between the quantity of venom introduced in the body of the prey and the distribution volume should ensue in a critical threshold of scorpion toxin plasma concentration. In this case, there is a massive release of neurohormonal mediators (mainly catecholamine), with systemic vasoconstrictor effects eliciting a sharp increase in systemic arterial pressure and LV-filling pressure and decreased cardiac output. This early phase of cardiac dysfunction, also called "vascular phase", is followed by a severe cardiomyopathy, a form of Takotsubo cardiomyopathy, involving both ventricles and reversible in days to weeks. The more comprehensive understanding of the disease pathophysiology has allowed for a well-codified symptomatic treatment, thus contributing to a substantial reduction in the death toll of scorpion envenomation over the past few decades. The standard intensive-care treatment (when available) overcomes envenomation's consequences such as acute pulmonary edema and cardiogenic shock. Even though it continues to inspire many evaluative studies, immunotherapy seems less attractive because of the major role held by mediators in the pathogenesis of envenomation, and unfavorable pharmacokinetic properties to existing sera compared to venom. Meta-analyses of controlled trials of immunotherapy in severe scorpion envenomation reached similar conclusions: there is an acceptable level of evidence in favor of the use of scorpion antivenom (Fab'2) against Centruroides sp. in USA/Mexico, while there is still a need for a higher level of evidence for immunotherapy in the Old World envenomation.
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Chakroun-Walha O, Karray R, Jerbi M, Nasri A, Issaoui F, Amine BR, Bahloul M, Bouaziz M, Ksibi H, Rekik N. Update on the Epidemiology of Scorpion Envenomation in the South of Tunisia. Wilderness Environ Med 2018; 29:29-35. [DOI: 10.1016/j.wem.2017.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 01/18/2023]
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Abroug F, Ouanes I, Maatouk M, Golli M, Ouanes-Besbes L. Inverted Takotsubo syndrome in Androctonus australis scorpion envenomation. Clin Toxicol (Phila) 2017; 56:381-383. [DOI: 10.1080/15563650.2017.1377221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Fekri Abroug
- Intensive Care Unit and Research Laboratory LR12SP15, CHU Fatouma Bourguiba, University of Monastir, Monastir, Tunisia
| | - Islem Ouanes
- Intensive Care Unit and Research Laboratory LR12SP15, CHU Fatouma Bourguiba, University of Monastir, Monastir, Tunisia
| | - Mezri Maatouk
- Radiology Department, CHU Fatouma Bourguiba, University of Monastir, Monastir, Tunisia
| | - Mondher Golli
- Radiology Department, CHU Fatouma Bourguiba, University of Monastir, Monastir, Tunisia
| | - Lamia Ouanes-Besbes
- Intensive Care Unit and Research Laboratory LR12SP15, CHU Fatouma Bourguiba, University of Monastir, Monastir, Tunisia
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Elatrous S, Ouanes-Besbes L, Ben Sik-Ali H, Hamouda Z, BenAbdallah S, Tilouche N, Jalloul F, Fkih-Hassen M, Dachraoui F, Ouanes I, Abroug F. Study of severe scorpion envenoming following subcutaneous venom injection into dogs: Hemodynamic and concentration/effect analysis. Toxicon 2015; 104:1-6. [PMID: 26166304 DOI: 10.1016/j.toxicon.2015.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 06/27/2015] [Accepted: 07/01/2015] [Indexed: 11/30/2022]
Abstract
To evaluate the dose-effects of Androctonus australis hector (Aah) venom injected subcutaneously on hemodynamics and neurohormonal secretions, 10 anesthetized and ventilated mongrel dogs, were split in two groups (n = 5/group). Subcutaneous injection was done with either 0.2 mg/kg or 0.125 mg/kg of the purified G50 scorpion toxic fraction. Hemodynamic parameters using right heart catheter were recorded and plasma concentrations of catecholamine, troponin, and serum toxic fraction were measured sequentially from baseline to 120 min. We identified the dose of toxic fraction evoking characteristic hemodynamic perturbation of severe envenomation, the time-lapse to envenomation, and the associated plasma level. The injection of 0.125 mg/kg toxic fraction was not associated with significant variations in hemodynamic parameters, whereas the 0.2 mg/kg dose caused envenomation characterized by significant increase in plasma catecholamines, increased pulmonary artery occluded pressure, mean arterial pressure, and systemic vascular resistance (p < 0.05), in association with sustained decline in cardiac output (p < 0.001). Envenomation occurred by the 30th minute, and the corresponding concentration of toxic fraction was 1.14 ng/ml. The current experiment allowed the identification of the sub-lethal dose (0.2 mg/kg) of the toxic fraction of Aah administered by the subcutaneous route. Two parameters with potential clinical relevance were also uncovered: the time-lapse to envenomation and the corresponding concentration of toxic fraction.
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Affiliation(s)
- Souheil Elatrous
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Tahar Sfar. Mahdia, University of Monastir, Tunisia.
| | - Lamia Ouanes-Besbes
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
| | - Habiba Ben Sik-Ali
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Tahar Sfar. Mahdia, University of Monastir, Tunisia
| | - Zineb Hamouda
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
| | - Saoussen BenAbdallah
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
| | - Nejla Tilouche
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Tahar Sfar. Mahdia, University of Monastir, Tunisia
| | - Faten Jalloul
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
| | - Mohamed Fkih-Hassen
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Tahar Sfar. Mahdia, University of Monastir, Tunisia
| | - Fahmi Dachraoui
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
| | - Islem Ouanes
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
| | - Fekri Abroug
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
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Abroug F, Ouanes-Besbes L, Elatrous S. Should dobutamine be used in severe scorpion envenomation. Clin Toxicol (Phila) 2015; 53:584. [DOI: 10.3109/15563650.2015.1052501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abroug F, Souheil E, Ouanes I, Dachraoui F, Fekih-Hassen M, Ouanes Besbes L. Scorpion-related cardiomyopathy: Clinical characteristics, pathophysiology, and treatment. Clin Toxicol (Phila) 2015; 53:511-8. [PMID: 25851549 DOI: 10.3109/15563650.2015.1030676] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Scorpion envenomation is a threat to more than 2 billion people worldwide with an annual sting number exceeding one million. Acute heart failure presenting as cardiogenic shock or pulmonary edema, or both is the most severe presentation of scorpion envenomation accounting for 0.27% lethality rate. OBJECTIVE The purpose of this review is to characterize the scorpion-related cardiomyopathy, clarify its pathophysiological mechanisms, and describe potentially useful treatments in this particular context. METHODS We searched major databases on observational or interventional studies (whether clinical or experimental) on the cardiorespiratory consequences of scorpion envenomation and their treatment. No limit of age or language was imposed. A critical appraisal of the literature was conducted in order to provide a pathophysiological scheme that reconciles reported patterns of cardiovascular toxicity and hypotheses and assumptions made so far. RESULTS Early cardiovascular dysfunction is related to the so-called "vascular phase" of scorpion envenomation, which is related to a profound catecholamine-related vasoconstriction leading to a sharp increase in left ventricular (LV) afterload, thereby impeding LV emptying, and increasing LV filling pressure. Following this vascular phase, a myocardial phase occurs, characterized by a striking alteration in LV contractility (myocardial stunning), low cardiac output, and hypotensive state. The right ventricle involvement is symmetric to that of LV with a profound and reversible alteration in right ventricular performance. This phase is unique in that it is reversible spontaneously or under inotropic treatment. Scorpion myocardiopathy combines the features of takotsubo myocardiopathy (or stress myocardiopathy) which is linked to a massive release in catecholamines leading to myocardial ischemia through coronary vasomotor abnormalities (epicardial coronary spasm and/or increase in coronary microvascular resistance). Treatment of pulmonary edema due to scorpion envenomation follows the same principles as those applied for the treatment of cardiogenic pulmonary edema in general: this begins with oxygen supplementation targeting an oxygen saturation of 92% or more, by oxygen mask, continuous positive airway pressure, noninvasive ventilation, or conventional mechanical ventilation. Dobutamine effectively improves hemodynamic parameters and may reduce mortality in severe scorpion envenomation. CONCLUSION Scorpion cardiomyopathy is characterized by a marked and reversible alteration in biventricular performance. Supportive treatment relying on ventilatory support and dobutamine infusion is a bridge toward recovery in the majority of patients.
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Affiliation(s)
- Fekri Abroug
- Intensive Care Unit Centre, Hospitalier Universitaire Fatouma Bourguiba , Monastir , Tunisia
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Impact of Hydrocortisone Hemisuccinate Use on Outcome of Severe Scorpion-Envenomed Adult Patients. Am J Ther 2014; 21:e181-8. [DOI: 10.1097/mjt.0b013e3182583bbc] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Bucaretchi F, Fernandes LC, Fernandes CB, Branco MM, Prado CC, Vieira RJ, De Capitani EM, Hyslop S. Clinical consequences of Tityus bahiensis and Tityus serrulatus scorpion stings in the region of Campinas, southeastern Brazil. Toxicon 2014; 89:17-25. [DOI: 10.1016/j.toxicon.2014.06.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/19/2014] [Accepted: 06/25/2014] [Indexed: 01/21/2023]
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Kumar RB, Suresh MX. Pharmacophore mapping based inhibitor selection and molecular interaction studies for identification of potential drugs on calcium activated potassium channel blockers, tamulotoxin. Pharmacogn Mag 2013; 9:89-95. [PMID: 23772102 PMCID: PMC3680861 DOI: 10.4103/0973-1296.111239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 04/06/2013] [Accepted: 04/30/2013] [Indexed: 11/10/2022] Open
Abstract
Background: Tamulotoxin (TmTx) from Buthus tamulus was found to be a highly venomous toxin which accelerates the neurotransmitter release that directly affects the cardiovascular tissues and the respiratory system leading to death. TmTx from red Indian scorpion is a crucial inhibitor for Ca2+ activated K+ channel in humans. Objective: The study is aimed at the identification of potential inhibitors of TmTx through pharmacophore based inhibitor screening and understanding the molecular level interactions. Materials and Method: The potential inhibitors for TmTx were identified using pharmacophore model based descriptor information present in existing drugs with the analysis of pharmacokinetic properties. The compounds with good ADMET (Absorption, Distribution, Metabolism, Excretion and Toxicity) descriptors were subjected to molecular interaction studies. The stability of bound toxin-inhibitor complex was studied using molecular dynamics simulation over a period of one nanosecond. Results: From a dataset of 3406 compounds, few compounds were selected as potential inhibitors based on the generated best pharmacophore models, pharmacokinetic analysis, molecular docking and molecular dynamics studies. Conclusion: In conclusion, two compounds containing better inhibition properties against TmTx are suggested to be better lead molecules for drug development in future and this study will help us to explore more inhibitors from natural origin against tamulotoxin.
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Affiliation(s)
- R Barani Kumar
- Department of Bioinformatics, Sathyabama University, Chennai, India
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Sofer S, Zucker N, Bilenko N, Levitas A, Zalzstein E, Amichay D, Cohen-Lahav M, Bernstein T. The importance of early bedside echocardiography in children with scorpion envenomation. Toxicon 2013; 68:1-8. [DOI: 10.1016/j.toxicon.2013.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 02/20/2013] [Accepted: 02/22/2013] [Indexed: 12/20/2022]
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Severe scorpion envenomation among children: does hydrocortisone improve outcome? A case-control study. Trans R Soc Trop Med Hyg 2013; 107:349-55. [DOI: 10.1093/trstmh/trt028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lethal Brain Edema, Shock, and Coagulopathy After Scorpion Envenomation. Wilderness Environ Med 2013; 24:23-7. [DOI: 10.1016/j.wem.2012.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 09/11/2012] [Accepted: 09/24/2012] [Indexed: 01/05/2023]
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Gokdemir M, Sezer T. Evaluation of myocardial function using tissue Doppler imaging in children with moderate scorpion envenomation. Clin Toxicol (Phila) 2013; 51:156-61. [DOI: 10.3109/15563650.2013.772622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bahloul M, Chaari A, Dammak H, Samet M, Chtara K, Chelly H, Ben Hamida C, Kallel H, Bouaziz M. Pulmonary edema following scorpion envenomation: Mechanisms, clinical manifestations, diagnosis and treatment. Int J Cardiol 2013; 162:86-91. [DOI: 10.1016/j.ijcard.2011.10.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/03/2011] [Accepted: 10/15/2011] [Indexed: 10/15/2022]
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Bahloul M, Chaari A, Dammak H, Bouaziz M. "Pulmonary edema induced by scorpion venom: evidence of cardiogenic nature". Int J Cardiol 2012; 158:292-3. [PMID: 22609008 DOI: 10.1016/j.ijcard.2012.04.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 04/14/2012] [Indexed: 10/28/2022]
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Bahloul M, Chabchoub I, Chaari A, Chtara K, Kallel H, Dammak H, Ksibi H, Chelly H, Rekik N, Ben Hamida C, Bouaziz M. Scorpion envenomation among children: clinical manifestations and outcome (analysis of 685 cases). Am J Trop Med Hyg 2010; 83:1084-92. [PMID: 21036842 PMCID: PMC2963974 DOI: 10.4269/ajtmh.2010.10-0036] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 04/19/2010] [Indexed: 11/07/2022] Open
Abstract
Our objective was to characterize both epidemiologically and clinically manifestations after severe scorpion envenomation and to define simple factors indicative of poor prognosis in children. We performed a retrospective study over 13 years (1990-2002) in the medical intensive care unit (ICU) of a university hospital (Sfax-Tunisia). The diagnosis of scorpion envenomation was based on a history of scorpion sting. The medical records of 685 children aged less than 16 years who were admitted for a scorpion sting were analyzed. There were 558 patients (81.5%) in the grade III group (with cardiogenic shock and/or pulmonary edema or severe neurological manifestation [coma and/or convulsion]) and 127 patients (18.5%) in the grade II group (with systemic manifestations). In this study, 434 patients (63.4%) had a pulmonary edema, and 80 patients had a cardiogenic shock; neurological manifestations were observed in 580 patients (84.7%), 555 patients (81%) developed systemic inflammatory response syndrome (SIRS), and 552 patients (80.6%) developed multi-organ failure. By the end of the stay in the ICU, evolution was marked by the death in 61 patients (8.9%). A multivariate analysis found the following factors to be correlated with a poor outcome: coma with Glasgow coma score ≤ 8/15 (odds ratio [OR] = 1.3), pulmonary edema (OR = 2.3), and cardiogenic shock (OR = 1.7). In addition, a significant association was found between the development of SIRS and heart failure. Moreover, a temperature > 39°C was associated with the presence of pulmonary edema, with a sensitivity at 20.6%, a specificity at 94.4%, and a positive predictive value at 91.7%. Finally, blood sugar levels above 15 mmol/L were significantly associated with a heart failure. In children admitted for severe scorpion envenomation, coma with Glasgow coma score ≤ 8/15, pulmonary edema, and cardiogenic shock were associated with a poor outcome. The presence of SIRS, a temperature > 39°C, and blood sugar levels above 15 mmol/L were associated with heart failure.
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Affiliation(s)
- Mabrouk Bahloul
- Service de Réanimation Médicale, Centre Hospitalo-Universitaire Habib Bourguiba, Sfax Tunisie.
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Abstract
OBJECTIVE To compare the efficacy of Dobutamine and Prazosin in the management of cases with scorpion sting. SETTING Pediatric intensive care unit of an affiliated hospital of a medical university. SUBJECTS Forty-two children with scorpion sting. INTERVENTION The involved victims were divided alternatively into two groups. Twenty-one patients were treated with intravenous Dobutamine infusion and other 21 received oral Prazosin. OUTCOME MEASURES Percent-rise in left-ventricular ejection fraction in first 24 h after institution of the therapy, time taken in recovery from pulmonary edema, requirement of any additional drug and supportive measures, and mortality. RESULTS The time taken in recovery from pulmonary edema was significantly shorter in cases treated with prazosin (28 +/- 18.3 vs. 72 +/- 0 h), the p-value being <0.05. Faster improvement of various parameters was observed in prazosin group in comparison to the dobutamine group. Mortality in both the groups was equal. CONCLUSION Prazosin and dobutamine, both are useful drugs for management of cardiovascular features of scorpion envenomation, nevertheless, prazosin is slightly better than dobutamine in terms of faster recovery, and also because of its ease of administration and low cost of therapy.
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Affiliation(s)
- B D Gupta
- Department of Pediatrics, Umaid Hospital for Women & Children, Regional Institute of Maternal & Child Health, Dr Sampurnanand Medical College, Jodhpur, India
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Abstract
Acute right ventricular (RV) failure has until recently received relatively little attention in the cardiology, critical care or anaesthesia literature. However, it is frequently encountered in cardiac surgical cases and is a significant cause of mortality in patients with severe pulmonary hypertension who undergo non-cardiac surgery. RV dysfunction may be primarily due to impaired RV contractility, or volume or pressure overload. In these patients, an increased pulmonary vascular resistance (PVR) or a decreased aortic root pressure may lead to RV ischaemia, resulting in a rapid, downward haemodynamic spiral. The key aspects of 'RV protection' in patients who are at risk of perioperative decompensation are prevention, detection and treatment aimed at reversing the underlying pathophysiology. Minimising PVR and maintaining systemic blood pressure are of central importance in the prevention of RV decompensation, which is characterised by a rising central venous pressure and a falling cardiac output. Although there are no outcome data to support any therapeutic strategy for RV failure when PVR is elevated, the combination of inhaled iloprost or intravenous milrinone with oral sildenafil produces a synergistic reduction in PVR, while sparing systemic vascular resistance. Levosimendan is a promising new inotrope for the treatment of RV failure, although its role in comparison to older agents such as dobutamine, adrenaline and milrinone has yet to be determined. This is also the case for the use of vasopressin as an alternative pressor to noradrenaline. If all else has failed, mechanical support of the RV should be considered in selected cases.
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Affiliation(s)
- P Forrest
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Haddad F, Couture P, Tousignant C, Denault AY. The right ventricle in cardiac surgery, a perioperative perspective: II. Pathophysiology, clinical importance, and management. Anesth Analg 2009; 108:422-33. [PMID: 19151265 DOI: 10.1213/ane.0b013e31818d8b92] [Citation(s) in RCA: 158] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The importance of right ventricular (RV) function in cardiovascular disease and cardiac surgery has been recognized for several years. RV dysfunction has been shown to be a significant prognostic factor in cardiac surgery and heart transplantation. In the first article of this review, key features of RV anatomy, physiology, and assessment were presented. In this second part, we review the pathophysiology, clinical importance, and management of RV failure in cardiac surgery.
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Affiliation(s)
- François Haddad
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Bouaziz M, Bahloul M, Kallel H, Samet M, Ksibi H, Dammak H, Ahmed MNB, Chtara K, Chelly H, Hamida CB, Rekik N. Epidemiological, clinical characteristics and outcome of severe scorpion envenomation in South Tunisia: multivariate analysis of 951 cases. Toxicon 2008; 52:918-26. [PMID: 18930073 DOI: 10.1016/j.toxicon.2008.09.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 09/08/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
Abstract
The aim of this retrospective descriptive study was to describe both epidemiologically and clinically manifestations following severe scorpion envenomation and to define simple predictive factors which can be used in routine practice in general Intensive Care Units (ICU) as an indicator of poor prognosis. Cases were collected from hospital patients' files during 13-year (1990-2002) period in the medical Intensive Care Unit of a university hospital (Sfax - Tunisia). The diagnosis of scorpion envenomation was based on a history of scorpion sting. Nine hundred fifty-one patients, who were admitted for a scorpion sting, were analyzed. There were 769 patients (80.8%) in the grade III group (with cardiogenic shock and/or pulmonary edema or severe neurological manifestation (coma and/or convulsion)) and 182 patients (19.2%) in the grade II group (with systemic manifestations). Scorpion envenomation is more frequent in summer; indeed 82.3% of our patients were admitted between June and September. The mean age (+/-SD) was 14.7 +/- 17.4 years, ranging from 0.5 to 90 years. In this study 739 patients (77.8%) had neuromuscular signs, 700 patients (73.6%) had gastrointestinal signs and 585 patients (61.5%) had a pulmonary edema, while 195 patients (20.5%) had a cardiogenic shock. The mean blood sugar on admission was at 11.32 +/- 5.66 mmol/l, a high blood sugar level (>11 mmol/l) was observed in 39% of cases. The mean blood urea was at 7.1 +/- 3.2 mmol/l, it was above 10 mmol/l in 10.7% of cases. The mean of leucocytes was at 17 418 +/- 7833 cells/mm(3), it was above 11 000/mm(3) in 80% of cases. In the end of the stay in ICU, evolution was marked by the improvement of 879 patients (92.5%) while 72 patients (7.5%) died. A multivariate analysis found the following factors to be correlated with a poor outcome: age less than 5 years (OR = 2.27), fever >38.5 degrees C (OR = 2.79), coma with Glasgow coma score < or =8/15 (OR = 9.87), pulmonary edema (OR = 8.46), leucocytes >25 000 cells/mm3 (OR = 2.35) and blood urea >8 mmol/l (OR = 4.02). Moreover, in children group, a significant association was found between PRISM score and mortality rate, this model had a high discriminative power with an area under the ROC curve at 0.93. In the adult patients a significant association was found between SAPS II score and mortality rate, this model had a high discriminative power with an area under the ROC curve at 0.82. In summary, in severe scorpion envenomation, age less than 5 years, fever >38.5 degrees C, coma with Glasgow coma score < or =8/15, pulmonary edema, leucocytes >25 000 cells/mm3 and blood urea >8 mmol/l were associated with a poor outcome.
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Affiliation(s)
- Mounir Bouaziz
- Service de Réanimation médicale, CHU Habib Bourguiba Route el Ain Km 1, 3029 Sfax Tunisie
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Bencheikh RS, Khattabi A, Faraj Z, Semlali I. [Management of scorpion sting in Morocco]. ACTA ACUST UNITED AC 2008; 27:317-22. [PMID: 18439797 DOI: 10.1016/j.annfar.2008.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 01/31/2008] [Indexed: 11/18/2022]
Abstract
Scorpion stings are the first cause of poisoning, and represent between 30 and 50% of all cases reported to the Moroccan Poison Control Centre. Concerned by the size of the problem, we have paid special attention to this pathology. Through retrospective and prospective studies, it has been possible to determine the nature and the chronology of clinical stages, as well as the epidemiological, clinical and therapeutic factors of gravity. On this basis, we worked out a new management to provide support for patients. This management will standardize support provided at the national level, and will reduce the number of lethal case and rationalize spending by reviewing medication, transfer of patients and hospital care. This standardization is an essential component of the national strategy against scorpion poisoning. Other components include training of medical staff, awareness campaigns, and information systems to monitor lethal cases. A survey over five years shows a reduction in the number of lethal cases and rationalization of costs. Medical care provided rests upon the distinction between patients stung by scorpions and patients actually poisoned. The first category of patients will be monitored up to four hours after the scorpion sting, while poisoned patients will be transferred to an intensive care unit.
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Affiliation(s)
- R Soulaymani Bencheikh
- Centre antipoison et de pharmacovigilance du Maroc, Rabat-Institut, rue Lamfadel-Cherkaoui, Madinate-Al-Irfane, B.P. 6671, Rabat, Maroc
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El-Alfy AT, Ahmed AA, Fatani AJ, Kader F. Amelioration of the cardiovascular manifestations of the yellow scorpion Leiurus quinquestriatus envenomation in rats by red grape seeds proanthocyanidins. Toxicon 2008; 51:321-33. [DOI: 10.1016/j.toxicon.2007.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Revised: 07/02/2007] [Accepted: 07/03/2007] [Indexed: 10/23/2022]
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Soualmia H, Abroug F, Djeridane Y. Effect and mechanisms underlying scorpion toxin action from Androctonus australis garzonii on atrial natriuretic peptide in rat atria: an in vitro study. Peptides 2008; 29:364-8. [PMID: 18191303 DOI: 10.1016/j.peptides.2007.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 11/27/2007] [Accepted: 11/29/2007] [Indexed: 11/25/2022]
Abstract
Scorpion envenomation is considered public health problem in Northern African countries. The mechanisms of cardiac dysfunction following scorpion envenomation are not fully understood. This study examined the effect and mechanisms underlying scorpion toxin action from Androctonus australis garzonii on atrial natriuretic peptide (ANP) release from rat atrium using in vitro organ perifusion. Male Sprague Dawley rats were used in this study. Three experiments were conducted. In experiment 1, atrial tissues were exposed either to Krebs-bicarbonate buffer medium (control) or to scorpion toxin (10(-8) M to 10(-6) M). In experiment 2, animals were chemically sympathectomized with a single intraperitoneal injection of 6-hydroxydopamine (6-OHDOPA) at a dose of 40 microg/g 24 h before sacrifice. Vehicle-treated rats served as control. Atrial tissues were collected and perifused in the presence of 10(-6) M scorpion toxin. In experiment 3, atrial tissues were exposed to 10(-6) M scorpion toxin either in the absence or presence of 10(-6) M propranolol (a beta-adrenoceptor blocker), or 10(-6) M tetrodotoxin (a sodium channel blocker). ANP levels released in the perifusion medium were determined by radioimmunoassay. The scorpion toxin at 10(-6) M induced a significant (p<0.01) increase (106%) in ANP levels. This effect was decreased (20%) by 6-OHDOPA. Propranolol and tetrodotoxin significantly (p<0.01) inhibited 55% and 60%, respectively, the toxin-induced ANP release. The data show that the North African scorpion toxin from Androctonus australis garzonii increases the ANP release in rat atrium through stimulation of sympathetic cardiac nerves and sodium channels activation.
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Affiliation(s)
- Hayet Soualmia
- Institut Supérieur des Technologies Médicales, Tunis, Tunisia
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31
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Bouaziz M, Bahloul M, Hergafi L, Kallel H, Chaari L, Hamida CB, Chaari A, Chelly H, Rekik N. Factors associated with pulmonary edema in severe scorpion sting patients--a multivariate analysis of 428 cases. Clin Toxicol (Phila) 2006; 44:293-300. [PMID: 16749548 DOI: 10.1080/15563650600584501] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine clinical and routine laboratory factors associated with pulmonary edema secondary to scorpion envenomation. DESIGN AND SETTING Retrospective study covering 13 years (1990-2002) in the medical Intensive Care Unit of a university hospital (Sfax-Tunisia). PATIENTS 428 patients older than 3 years who were admitted to the intensive care unit for scorpion envenomation were included in this study. Patients were stratified into two groups according to the presence or absence of pulmonary edema as assessed by a medical committee. MEASUREMENTS AND RESULTS The mean (+/- SD) age was 17.5 +/- 17.7 years, ranging from 3 to 76 years. The pulmonary edema group included 294 patients (68.7%). A multivariate analysis found the following factors to be correlated with a pulmonary edema: age less than 5 years (p = 0.04), sweating (p = 0.004), agitation (p = 0.01), leukocytes of 25000 cells/mm3 or more (p = 0.02), and a plasma protein concentration of 72 g/L or more (p < 0.0001). In addition, a plasma protein concentration of 72 g/L or more predicted the presence of pulmonary edema with a sensitivity of 78% a specificity of 88%, a positive predictive value of 93%, and negative predictive value of 64%. Almost 84% of patients having a respiratory rate of > or = 30 breaths/minute associated with agitation and sweating were classified in the pulmonary edema group. This clinical association indicates the presence of pulmonary edema with a specificity of 84.3% and a positive predictive value of 87.5%. CONCLUSION In scorpion envenomation patients older than 3 years, the association of a respiratory rate of > or = 30 breaths/minute, agitation, sweating, or the presence of high plasma protein concentrations suggest the presence of pulmonary edema.
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Affiliation(s)
- Mounir Bouaziz
- Service de Réanimation Médicale, CHU Habib Bourguiba Sfax-Tunisie.
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Nouira S, Elatrous S, Besbes L, Boukef R, Devaux C, Aubrey N, Elayeb M, Abroug F. Neurohormonal activation in severe scorpion envenomation: correlation with hemodynamics and circulating toxin. Toxicol Appl Pharmacol 2005; 208:111-6. [PMID: 16183384 DOI: 10.1016/j.taap.2005.01.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 12/23/2004] [Accepted: 01/31/2005] [Indexed: 11/30/2022]
Abstract
We studied the effects of scorpion (Androctonus australis hector) venom on hemodynamics and on the release of catecholamines, neuropeptide Y (NPY), endothelin-1 (ET-1) and atrial natriuretic peptide (ANP) in dog model of severe scorpion envenomation. Nine mongrel anesthetized dogs were submitted to mechanical ventilation through intubation and were administered intravenously purified dried scorpion venom (Androctonus autstralis) 0.05 mg/kg. Measurements including pulmonary artery catheter derived parameters, serum toxin levels and humoral variables were performed at baseline (before venom injection) and 5, 15, 30 and 60 min after venom injection. Humoral variables included: serum lactate, epinephrine (EP), norepinephrine (NE), NPY, ET-1 and ANP plasma concentrations. Scorpion venom caused rapid and transient increase of mean arterial pressure (MAP) and PAOP associated with a marked and sustained decline in cardiac output (-55% at 60 min; P < 0.001). Hemodynamic changes were associated with a rapid and significant increase of all measured hormones. The highest increase was for NE (28-fold) and EP (25-fold). MAP was closely correlated with NE and less significantly correlated with toxin levels. Similarly, significant correlation was observed between PAPO and ANP plasma levels. These findings support the implication of excessive catecholamines release in hemodynamic disturbances of severe SE and suggest that NPY and ET-1 could be involved in this process. Serum toxin does not appear to consistently contribute to these effects. Through its correlation with PAOP, ANP could be a reliable and useful marker of cardiac dysfunction in SE.
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Affiliation(s)
- Semir Nouira
- Service de Réanimation Médicale and Experimental Toxicology Unit (99/UR/088-59 and UR/06/02), Fattouma Bourguiba University Hospital Monastir 5000, Tunisia.
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Bahloul M, Kallel H, Rekik N, Ben Hamida C, Chelly H, Bouaziz M. [Cardiovascular dysfunction following severe scorpion envenomation. Mechanisms and physiopathology]. Presse Med 2005; 34:115-20. [PMID: 15687982 DOI: 10.1016/s0755-4982(05)88241-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The seriousness of scorpion envenomation results essentially from left cardiac function with pulmonary oedema and/or a state of shock. Adrenergic myocarditis, toxic myocarditis and myocardial ischemia are the 3 mechanisms that explain the cardiac dysfunction. Myocardial ischemia is not only due to the release of catecolamines but also the effect of the cytokines and/or neuropeptide Y on the coronary vessels. The cardiac damage can be due or enhanced by the depressive effect of the cytokines on the myocardial cells. The frequently observed hyperglycaemia only enhances the state of the already damaged myocardium.
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Affiliation(s)
- Mabrouk Bahloul
- Service de réanimation médicale, CHU Habib Bourguiba, Sfax, Tunisie.
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Abstract
This article focuses on the medically relevant arachnid species found in North America and selected other arachnids from around the world. While it is largely still true that the geographic location of the envenomation assists in determining the species responsible, the booming trade in arachnids as exotic pets should prompt the clinician to inquire into this possibility. Expert advice should be sought in either case; species identification is critical in determining the need for and proper type of antivenom therapy.
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Affiliation(s)
- John R Saucier
- University of Vermont School of Medicine, Burlington 05405, USA.
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Michard F, Alaya S, Zarka V, Bahloul M, Richard C, Teboul JL. Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest 2003; 124:1900-8. [PMID: 14605066 DOI: 10.1378/chest.124.5.1900] [Citation(s) in RCA: 278] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To assess the value of the global end-diastolic volume (GEDV) evaluated by transpulmonary thermodilution as an indicator of cardiac preload. DESIGN Prospective clinical study. SETTING Medical ICU of a university hospital (20 beds). PATIENTS Thirty-six patients with septic shock. INTERVENTIONS Volume loading and dobutamine infusion. MEASUREMENTS AND RESULTS Hemodynamic parameters were evaluated in triplicate by the transpulmonary thermodilution technique: (1) before and after 66 fluid challenges in 27 patients, and (2) before and after 28 increases in dobutamine infusion rate in 9 patients. Volume loading induced a significant (p < 0.001) increase in central venous pressure (CVP) from 10 +/- 4 to 13 +/- 4 mm Hg, in GEDV index from 711 +/- 164 to 769 +/- 144 mL/m(2), in stroke volume index (SVI) from 36 +/- 12 to 42 +/- 12 mL/m(2), and in cardiac index (CI) from 3.4 +/- 1.1 to 3.9 +/- 1.2 L/min/m(2) (mean +/- SD). Changes in GEDV index were correlated (r = 0.72, p < 0.001) with changes in SVI, while changes in CVP were not. The increase in SVI was > 15% in 32 of 66 instances (positive response). The preinfusion GEDV index was lower (637 +/- 134 mL/m(2) vs 781 +/- 161 mL/m(2), p < 0.001) in the cases of positive response, and was negatively correlated with the percentage increase in GEDV index (r = - 0.65, p < 0.001) and in SVI (r = - 0.5, p < 0.001). Dobutamine infusion induced an increase in SVI (32 +/- 11 mL/m(2) vs 35 +/- 12 mL/m(2), p < 0.05) and in CI (2.8 +/- 0.6 L/min/m(2) vs 3.2 +/- 0.6 L/min/m(2), p < 0.001) but no significant change in CVP (13 +/- 3 mm Hg vs 13 +/- 3 mm Hg) and in GEDV index (823 +/- 221 mL/m(2) vs 817 +/- 202 mL/m(2)). CONCLUSION In patients with septic shock, our findings demonstrate that, in contrast to CVP, the transpulmonary thermodilution GEDV index behaves as an indicator of cardiac preload.
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Affiliation(s)
- Frédéric Michard
- Medical Intensive Care Unit, Bicêtre Hospital, University Paris XI, France.
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Bahloul M, Ben Hamida C, Chtourou K, Ksibi H, Dammak H, Kallel H, Chaari A, Chelly H, Guermazi F, Rekik N, Bouaziz M. Evidence of myocardial ischaemia in severe scorpion envenomation. Myocardial perfusion scintigraphy study. Intensive Care Med 2003; 30:461-7. [PMID: 14673518 DOI: 10.1007/s00134-003-2082-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2002] [Accepted: 10/28/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To explore the myocardial perfusion by thallium-201 scintigraphy for patients with evidence of myocardial damage after scorpion envenomation. DESIGN Prospective study over 1-year period. SETTING Medical intensive care unit of a university hospital (Sfax, Tunisia). PATIENTS We have prospectively included six patients admitted for scorpion envenomation over a period of 1 year in the 22-bed intensive care unit (ICU) of our university hospital. The evidence of myocardial damage was confirmed by electrocardiography and echocardiography in all patients. Myocardial perfusion scintigraphy ((201)Tl scintigraphy) coupled with radionuclide ventriculography ((99m)Tc) was performed for all patients, occurring 32 h on average (range 12-72 h) after the sting. RESULTS Radionuclide ventriculography was abnormal in all cases; the abnormalities observed were similar to those observed by echocardiography. Moreover (201)Tl scintigraphy showed evidence of myocardial hypoperfusion in all cases. The myocardial hypoperfusion grade and localisation were more marked in the abnormal localisation shown by echocardiography and electrocardiography, compared to the normal wall. Repeated studies, obtained only in two patients within 6 and 15 days, respectively, showed considerable, but not complete, improvement of wall motion and myocardial perfusion. Segments with improved perfusion showed greatly improved regional wall motion. CONCLUSION This study confirms the evidence of myocardial hypoperfusion after severe scorpion envenomation.
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Affiliation(s)
- Mabrouk Bahloul
- Service de Réanimation médicale, CHU Habib Bourguiba, Route el Ain Km 1, 3029 Sfax, Tunisia
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Abroug F, Nouira S, El Atrous S, Besbes L, Boukef R, Boussarsar M, Marghli S, Eurin J, Barthelemy C, El Ayeb M, Dellagi K, Carayon A. A canine study of immunotherapy in scorpion envenomation. Intensive Care Med 2003; 29:2266-2276. [PMID: 12955186 DOI: 10.1007/s00134-003-1947-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2003] [Accepted: 07/15/2003] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effects of scorpion venom and antivenom in experimental envenomation. DESIGN Prospective, controlled animal study. SETTING University research laboratory SUBJECTS Twenty-nine anesthetized and ventilated dogs. INTERVENTIONS The first group of animals had venom alone (0.05 mg/kg). Animals from the second group had simultaneous administration of 10 ml of scorpion antivenom (SAV). In the third and fourth groups, 10 ml and 40 ml SAV, respectively, were injected 10 min following venom. MEASUREMENTS AND RESULTS Hemodynamic parameters using right heart catheter were recorded and dosage of catecholamines, neuropeptide Y (NPY), endothelin-1, and atrial natriuretic peptide (ANP) were performed at baseline and during 60 min following envenomation. In the control group, at 5 min, there was a sharp increase in pulmonary artery occluded pressure (PAOP, from 2 mmHg to 23 mmHg), mean arterial pressure (MAP, from 125 mmHg to 212 mmHg) and systemic vascular resistance (SVR, from 2450 dyn sec(-1 )m(5) to 5775 dyn sec(-1 )m(5), P<0.05 for all). Heart rate, cardiac output, and stroke volume decreased. There was a 40-fold increase in epinephrine and norepinephrine plasma concentrations. Circulating NPY and ANP dosages increased too. PAOP and MAP decreased thereafter to reach baseline levels. Simultaneous administration of SAV with venom totally offset the hallmarks of scorpion envenomation. Delayed administration of SAV at any dosage failed to alter the features of scorpion envenomation. CONCLUSION While simultaneous administration of SAV and scorpion venom is effective in preventing scorpion envenomation-related manifestations, delayed administration of SAV, either at standard or elevated dosages, failed to alter any of the scorpion envenomation features.
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Affiliation(s)
- Fekri Abroug
- Intensive Care Unit, CHU F Bourguiba, 5000, Monastir, Tunisia.
- Unité de Recherche (99/UR/088-59), Faculté de Médecine, Monastir, Tunisia.
| | - Semir Nouira
- Intensive Care Unit, CHU F Bourguiba, 5000, Monastir, Tunisia
- Unité de Recherche (99/UR/088-59), Faculté de Médecine, Monastir, Tunisia
| | - Souheil El Atrous
- Unité de Recherche (99/UR/088-59), Faculté de Médecine, Monastir, Tunisia
| | - Lamia Besbes
- Intensive Care Unit, CHU F Bourguiba, 5000, Monastir, Tunisia
- Unité de Recherche (99/UR/088-59), Faculté de Médecine, Monastir, Tunisia
| | - Riadh Boukef
- Intensive Care Unit, CHU F Bourguiba, 5000, Monastir, Tunisia
- Unité de Recherche (99/UR/088-59), Faculté de Médecine, Monastir, Tunisia
| | - Mohamed Boussarsar
- Intensive Care Unit, CHU F Bourguiba, 5000, Monastir, Tunisia
- Unité de Recherche (99/UR/088-59), Faculté de Médecine, Monastir, Tunisia
| | - Soudani Marghli
- Intensive Care Unit, CHU F Bourguiba, 5000, Monastir, Tunisia
- Unité de Recherche (99/UR/088-59), Faculté de Médecine, Monastir, Tunisia
| | - Joëlle Eurin
- Laboratoire de Biochimie, Upres 1390 CHU, Pitié-Salpêtrière, Paris, France
| | | | | | | | - Alain Carayon
- Laboratoire de Biochimie, Upres 1390 CHU, Pitié-Salpêtrière, Paris, France
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38
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Fischer LG, Aken HV, Bürkle H. Management of pulmonary hypertension: physiological and pharmacological considerations for anesthesiologists. Anesth Analg 2003; 96:1603-1616. [PMID: 12760982 DOI: 10.1213/01.ane.0000062523.67426.0b] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lars G Fischer
- Department of Anesthesiology and Intensive Care, Universita[Combining Diaeresis]tsklinikum Mu[Combining Diaeresis]nster, Mu[Combining Diaeresis]nster, Germany
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39
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Abstract
Eight children aged 2-9 years, with signs and symptoms of severe scorpion envenoming by Tityus serrulatus were studied. All patients showed clinical manifestations of cardiac dysfunction, with ECG and echocardiographic alteration and five developed pulmonary edema. Troponin I levels were normal in all patients on admission, except for two who arrived later, and increased thereafter, with maximum values being observed 24-36 h after the sting. The detection of TnI in patients with severe scorpion envenoming, and the observed temporal pattern and serum levels meet the criteria established for the diagnosis of acute myocardial infarction. The rapid reversibility of cardiac dysfunction, together with the normalization of the enzymatic, ECG and echocardiographic data, indicates the occurrence of an acute myocardial lesion without underlying or associated coronary disease.
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Affiliation(s)
- Palmira Cupo
- Department of Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, 14049-900 Ribeirão Preto SP, Brazil.
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