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Şanlıurfa’da Genel Yoğun Bakım Ünitemizde Akrep Sokmalarına Yaklaşım

Year 2023, Volume: 20 Issue: 1, 203 - 207, 27.04.2023
https://doi.org/10.35440/hutfd.1268102

Abstract

Amaç: Akrep sokmalarına bağlı olarak oluşan zehirlenmeler ve getirdiği sonuçlar dünyada güncelliğini koruyan sağlık problemlerindendir. Akrep sokmaları bölgemizde, özellikle ilimiz ve çevresinde yaygın olarak görülmektedir. Dünyada tanımlanmış olan 1500’den fazla akrep türünün sadece birkaç tanesi çok zehirlidir ve Türkiye’de 15 tür akrep bulunduğu tahmin edilmektedir. Bu çalışmada akrep sokması nedeniyle hastanemiz yoğun bakım ünitesi (YBÜ)’de takip ettiğimiz hastaların demografik verileri, epidemiyolojik, klinik özellikleri ve sonuçları değerlendirildi.
Materyal ve metod: Etik kurul onayı (HRÜ/23.03.11) alındıktan sonra Ocak 2013- Ocak 2023 tarihleri arasında Harran Üniversitesi Hastanesinde akrep sokması ön tanısıyla takip ve tedavi edilen hastaların arşiv verileri değerlendirildi. Sistemik belirti gösteren ve özellik arz eden erişkin hastalarla ilgili genel YBÜ’ deki tedavi yaklaşımları, epidemiyolojik ve klinik sonuçlar değerlendirildi.
Bulgular: Çalışmamıza dahil edilen, akrep sokması tanısıyla hastanemizde tedavi gören 1493 hastanın 910’u >17 yaş hastalardı. Bunların da 74’ü üçüncü seviye YBÜ’ de tedavi gören hastalardı. Erişkin YBÜ’ de tedavi gören hastaların %25,7’si (n= 19) erkek, %74,3’ü (n=55) kadındı. Hastaların yaşı 18 ile 88 arasında değişmekteydi. Kadın hastaların %43,6’sı (n=24) gebeydi. En sık görülen semptom, lokal ağrı (%98,6, n=73) idi. Çoğunlukla alt (%52,7) ve üst (%44,6) ekstremitelerin etkilendiği görüldü.
Hastaların %70,3’ü (n=52) profilaktik amaçlı tetanoz antiserum, %56,8’si (n=42) anti-venom tedavisi aldı. Gebe hastalara ağrı kesici olarak intravenöz parasetamol uygulandı. Gebe hastalara hastaneye yatışta ve taburculuk öncesi obstetrik USG yapılmış olup herhangi bir komplikasyona rastlanılmadan şifayla taburcu edildi. Hastaların tamamının şifayla taburcu edildiği görüldü.
Sonuç: Akrep sokmasına bağlı sistemik belirtileri olan ve gebelik gibi özellik arz eden durumu olan hastaların, YBÜ’de yakın takip ve tedavisi, ölüm oranlarının azaltılmasına katkı sağlayabilir. Akrep sokmalarına kırsal bölgelerde özellikle kadın hastalarda ve gebelerde sıklıkla rastlanılmaktadır. Bunun, bölgemizdeki tarım alanlarında çoğunlukla 15-49 yaş kadınların çalışmasına bağlı olabileceğini düşünmekteyiz. Bu sonuçların, yapılacak daha geniş kapsamlı halk sağlığı çalışmalarıyla desteklenmesi gerektiğini düşünmekteyiz.

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References

  • 1. Dehesa-Dávila M, Possani LD. Scorpionism and serotherapy in Mexico. Toxicon 1994;32(9):1015-1018. doi:10.1016/0041-0101(94)90383-2.
  • 2. Ozkan O, Kat I. Mesobuthus eupeus scorpionism in Sanliurfa region of Turkey. J Venom Anim Toxins Incl Trop Dis 2005;11(4):479-491. doi:10.1590/S1678-91992005000400008.
  • 3. Guler A, Karadas S, Kurdoglu Z. Gebelikte Akrep Sokmalarına Yaklaşım. 2011;(0505):8-11.
  • 4. Otero R, Navı́o E, Céspedes FA, Núñez MJ, Lozano L, Moscoso ER, et al. Scorpion envenoming in two regions of Colombia: clinical, epidemiological and therapeutic aspects. Trans R Soc Trop Med Hyg 2004;98(12):742-750. doi:10.1016/j.trstmh.2003.12.018.
  • 5. Abroug F, Ouanes-Besbes L, Tilouche N, Elatrous S. Scorpion envenomation: state of the art. Intensive Care Med 2020;46(3):401-410. doi:10.1007/s00134-020-05924-8.
  • 6. Abroug F, Souheil E, Ouanes I, Dachraoui F, Fekih-Hassen M, Ouanes Besbes L. Scorpion-related cardiomyopathy: Clinical characteristics, pathophysiology, and treatment. Clin Toxicol 2015;53(6):511-518. doi:10.3109/15563650.2015.1030676.
  • 7. Lourenço WR, Cloudsley-Thompson JL, Cuellar O, Eickstedt VRD, Von Barraviera B, Knox MB. The Evolution of Scorpionism in Brazil in Recent Years. J Venom Anim Toxins 1996;2(2):121-134. doi:10.1590/S0104-79301996000200005.
  • 8. Bosnak M, Ece A, Yolbas I, Bosnak V, Kaplan M, Gurkan F. Scorpion Sting Envenomation in Children in Southeast Turkey. Wilderness Environ Med 2009;20(2):118-124. doi:10.1580/07-WEME-OR-098RR3.1.
  • 9. Bahloul M, Chabchoub I, Chaari A, Chtara K, Kallel H, Dammak H, et al. Scorpion envenomation among children: Clinical manifestations and outcome (analysis of 685 cases). Am J Trop Med Hyg 2010;83(5):1084-1092. doi:10.4269/ajtmh.2010.10-0036.
  • 10. Yilmaz F, Arslan ED, Demir A, Kavalci C, Durdu T, Yilmaz MS, et al. Epidemiological, Clinical Characteristics and Outcomes of Scorpion Sting in Southeastern Region of Turkey. Turkish J Trauma Emerg Surg 2013;19(5):417-422. doi:10.5505/tjtes.2013.52333.
  • 11. Yakinci C, Kayhan E. Son beş yıldaki akrep sokması olgularımız Scorpion stings cases in the last five years. 2015;54(2):74-77.
  • 12. Bahloul M, Rekik N, Chabchoub I, Chaari A, Ksibi H, Kallel H, et al. Neurological complications secondary to severe scorpion envenomation. Med Sci Monit 2005;11(4):CR196-202. http://www.ncbi.nlm.nih.gov/pubmed/15795701.
  • 13. Krifi MN, Kharrat H, Zghal K, Abdouli M, Abroug F, Bouchoucha S, et al. Development of an ELISA for the detection of scorpion venoms in sera of humans envenomed by Androctonus australis garzonii (Aag) and Buthus occitanus tunetanus (Bot): correlation with clinical severity of envenoming in Tunisia. Toxicon 1998;36(6):887-900. doi:10.1016/S0041-0101(97)00136-0.
  • 14. Freire-Maia L, Campos JA, Amaral CFS. Approaches to the treatment of scorpion envenoming. Toxicon 1994;32(9):1009-1014. doi:10.1016/0041-0101(94)90382-4.

Approach to Scorpion Stings in our General Intensive Care Unit in Şanlıurfa

Year 2023, Volume: 20 Issue: 1, 203 - 207, 27.04.2023
https://doi.org/10.35440/hutfd.1268102

Abstract

Background: Poisoning due to scorpion stings and its consequences are among the health problems that remain current in the world. Scorpion stings are common in our region, especially in and around our city. Only a few of the more than 1500 scorpion species described in the world are very venomous and it is estimated that there are 15 species of scorpions in Turkey. In this study, the demographic data, epidemiological, clinical characteristics and results of the patients, which we followed up in our hospital’ s intensive care unit (ICU) due to scorpion stings were evaluated.
Materials and Methods: After obtaining the ethics committee approval, the archive data of the patients who were followed up and treated with the preliminary diagnosis of scorpion sting at Harran University Hospital between January 2013 and January 2023 were evaluated. The treatment approaches, epidemiological and clinical results in the general ICU, which were applied to adult patients with systemic symptoms and special conditions, were evaluated.
Results: Of the 1493 patients included in our study who were treated in our hospital with the diagnosis of scorpion sting, 910 were patients aged >17 years. Of these, 74 were patients who were treated in the third level ICU. Of the patients treated in the adult ICU, 25.7% (n=19) were male and 74.3% (n=55) were female. The age of the patients ranged from 18 to 88 years. 43.6% (n=24) of the female patients were pregnant. The most common symptom was local pain (98.6%, n=73). It was observed that the lower (52.7%) and upper (44.6%) extremities were mostly affected. Of the patients, 70.3% (n=52) received tetanus antiserum for prophylactic purposes and 56.8% (n=42) received anti-venom treatment. Intravenous paracetamol was administered to pregnant patients as a pain reliever. Pregnant patients underwent obstetric USG at admission and before discharge, and they were discharged without any complications. It was observed that all of the patients were discharged with cure.
Conclusions: Close follow-up and treatment in the ICU of patients with systemic symptoms due to scorpion stings and special conditions such as pregnancy may contribute to reducing mortality rates. Scorpion stings are frequently encountered in rural areas, especially in female patients and pregnant women. We think that this may be due to the fact that mostly women aged 15-49 work in agricultural areas in our region. We think that these results should be supported by more comprehensive public health studies.

Key Words: Scorpion sting, Intensive care, Antivenom, Pregnant

Project Number

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References

  • 1. Dehesa-Dávila M, Possani LD. Scorpionism and serotherapy in Mexico. Toxicon 1994;32(9):1015-1018. doi:10.1016/0041-0101(94)90383-2.
  • 2. Ozkan O, Kat I. Mesobuthus eupeus scorpionism in Sanliurfa region of Turkey. J Venom Anim Toxins Incl Trop Dis 2005;11(4):479-491. doi:10.1590/S1678-91992005000400008.
  • 3. Guler A, Karadas S, Kurdoglu Z. Gebelikte Akrep Sokmalarına Yaklaşım. 2011;(0505):8-11.
  • 4. Otero R, Navı́o E, Céspedes FA, Núñez MJ, Lozano L, Moscoso ER, et al. Scorpion envenoming in two regions of Colombia: clinical, epidemiological and therapeutic aspects. Trans R Soc Trop Med Hyg 2004;98(12):742-750. doi:10.1016/j.trstmh.2003.12.018.
  • 5. Abroug F, Ouanes-Besbes L, Tilouche N, Elatrous S. Scorpion envenomation: state of the art. Intensive Care Med 2020;46(3):401-410. doi:10.1007/s00134-020-05924-8.
  • 6. Abroug F, Souheil E, Ouanes I, Dachraoui F, Fekih-Hassen M, Ouanes Besbes L. Scorpion-related cardiomyopathy: Clinical characteristics, pathophysiology, and treatment. Clin Toxicol 2015;53(6):511-518. doi:10.3109/15563650.2015.1030676.
  • 7. Lourenço WR, Cloudsley-Thompson JL, Cuellar O, Eickstedt VRD, Von Barraviera B, Knox MB. The Evolution of Scorpionism in Brazil in Recent Years. J Venom Anim Toxins 1996;2(2):121-134. doi:10.1590/S0104-79301996000200005.
  • 8. Bosnak M, Ece A, Yolbas I, Bosnak V, Kaplan M, Gurkan F. Scorpion Sting Envenomation in Children in Southeast Turkey. Wilderness Environ Med 2009;20(2):118-124. doi:10.1580/07-WEME-OR-098RR3.1.
  • 9. Bahloul M, Chabchoub I, Chaari A, Chtara K, Kallel H, Dammak H, et al. Scorpion envenomation among children: Clinical manifestations and outcome (analysis of 685 cases). Am J Trop Med Hyg 2010;83(5):1084-1092. doi:10.4269/ajtmh.2010.10-0036.
  • 10. Yilmaz F, Arslan ED, Demir A, Kavalci C, Durdu T, Yilmaz MS, et al. Epidemiological, Clinical Characteristics and Outcomes of Scorpion Sting in Southeastern Region of Turkey. Turkish J Trauma Emerg Surg 2013;19(5):417-422. doi:10.5505/tjtes.2013.52333.
  • 11. Yakinci C, Kayhan E. Son beş yıldaki akrep sokması olgularımız Scorpion stings cases in the last five years. 2015;54(2):74-77.
  • 12. Bahloul M, Rekik N, Chabchoub I, Chaari A, Ksibi H, Kallel H, et al. Neurological complications secondary to severe scorpion envenomation. Med Sci Monit 2005;11(4):CR196-202. http://www.ncbi.nlm.nih.gov/pubmed/15795701.
  • 13. Krifi MN, Kharrat H, Zghal K, Abdouli M, Abroug F, Bouchoucha S, et al. Development of an ELISA for the detection of scorpion venoms in sera of humans envenomed by Androctonus australis garzonii (Aag) and Buthus occitanus tunetanus (Bot): correlation with clinical severity of envenoming in Tunisia. Toxicon 1998;36(6):887-900. doi:10.1016/S0041-0101(97)00136-0.
  • 14. Freire-Maia L, Campos JA, Amaral CFS. Approaches to the treatment of scorpion envenoming. Toxicon 1994;32(9):1009-1014. doi:10.1016/0041-0101(94)90382-4.
There are 14 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Erdoğan Duran 0000-0002-9606-8266

Orhan Binici 0000-0002-3158-8252

Ahmet Atlas 0000-0001-5999-0510

Veli Fahri Pehlivan 0000-0001-5661-4499

Başak Pehlivan 0000-0001-6985-343X

Evren Büyükfırat 0000-0002-6396-0426

Hakim Çelik 0000-0002-7565-3394

Mahmut Alp Karahan 0000-0002-7210-9481

Project Number yok
Early Pub Date April 27, 2023
Publication Date April 27, 2023
Submission Date March 20, 2023
Acceptance Date April 13, 2023
Published in Issue Year 2023 Volume: 20 Issue: 1

Cite

Vancouver Duran E, Binici O, Atlas A, Pehlivan VF, Pehlivan B, Büyükfırat E, Çelik H, Karahan MA. Şanlıurfa’da Genel Yoğun Bakım Ünitemizde Akrep Sokmalarına Yaklaşım. Harran Üniversitesi Tıp Fakültesi Dergisi. 2023;20(1):203-7.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty