الفهرس 
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Abstract
Scorpion envenomation is frequent in tropical and subtropical areas between 50° N and 50° S latitudes. It is a serious public health issue in the Middle East and northern Sahara.
The aim of this study is to assess the role of oxidative stress and inflammatory markers (IL-1β) release in development of cardiac and pancreatic complications associated with scorpion envenomation which will subsequently evaluate the use of antioxidants and (IL-1β) receptor blockers in treatment of scorpion envenomation.
This study was carried out over a period of 12 months; from the 1st of Jan 2021 till the 30th of Jan 2022 on 81 subjects diagnosed as scorpion poisoning. They were recruited from two centers in Minia governorate. These centers were the poisoning control centers at El Minia general hospital at Minia city and El-Minia university hospital also at Minia city. Their ages range from 13 to 45 years. Both sexes were included in the study. History and clinical examination were recorded on standardized report forms. Subjects were selected according to inclusion and exclusion criteria.
Subjects enrolled underwent clinical examination and investigations on admission), which involved 10 items: ECGs, TTEs, human troponin I (TN-I) measurement of (CBC) serum (Na +and K+), renal function tests (blood urea nitrogen and serum creatinine, (RBS), serum amylase, (MDA) and (IL-1β). All the biochemical investigations were done in Minia university hospital lab and interpreted with clinical pathologist. ECGs and TTEs were evaluated by a cardiologist.
The age of cases ranged from 13-45 years old, most of them were females;66.7%, while males represented 33.3 %. Regarding the occupation, 33.3% were students, 37% were housewives, and 29.6% were farmers. Concerning the site of sting ,25.9% of cases were at upper limb (UL), 63% were at lower limb (LL) ,7.4 % at trunk, while head 3.7%. With delay time ranged from 1.5 -11 hours.
The pulse ranged from 75-170 beat per minute with a mean ±SD of 114.8±31 beat per minute. Blood pressure, the SBP ranged from 90-150 mmHg with a mean ± SD of 121.5±15.9 mmHg, The DBP was between 60-100 mmHg with a mean ± SD of 80.4±11.8 mmHg., RR ranged from 20-55cycle per minute with a mean ± SD of 35.9±11.4 cycle per minute and GCS ranged from 5-15 with a mean ± SD of 12.6±2.7.
Regarding clinical presentation, Nausea, vomiting, abdominal pain, and headache occurred in 63% of cases; truncal hyperthermia occurred in 55.6% of cases.
Regarding biochemical investigations; hemoglobin (Hb) ranged from 9.5 to 12.5g/dl with a mean ±SD of 11.1±0.9 g/dl, total leucocytic count (TLC) ranged from 4-80 cell/Cmm with a mean ±SD of11.5±13.9 cell/Cmm, platelets (PLT) ranged from 150 to 500 cell/Cmm with a mean ± SD of 306.2±121.6 cell/ Cmm. Sodium level (Na+) ranged from 129 to 141mmol/L with a mean± SD of 134.3±3.3 mmol/L, potassium (K+) level ranged from 2.5 to 4.2 mmol/L with a mean ±SD of 3.3±0.4 mmol/L, blood urea ranged from 16 to 50mg/dl with a mean ± SD of 30.3±10.3mg/dl, serum creatinine 0.5-1mg/dl with a mean ±SD of 0.7±0.1mg/dl. Troponin I was normal in 44.4% of cases and abnormal in 55.6%, and ranged from 1 to 302 ng/ml with mean ±SD of 75.9±98.1ng/ml, serum amylase; ranged from 53 to 110U/l with mean ±SD of 83.7±15.8 U/l, random blood sugar (RBS) ranged from 133-400 mg/dl with mean ±SD of 230±73.5 U/l, IL-1β ranged from 46.7 to 89.3 pg/ml with mean ±SD of 67.9±14 pg/ml, and MDA ranged from1.5 to 3.8 nmol/ml with mean± SD of 2.5±0.6 nmol/ml.
Regarding ECG, our results showed that it was abnormal in 51 patient (63%) mostly with sinus tachycardia.
Regarding echocardiography, about 33.3% of our cases had aberrant echocardiographic findings, such as mitral regurge (MR), tricuspid regurge (TR), and irregular motion.
There were significant statistical differences between level of IL-1β and patients’ DBP, pulse and GCS in case of IL-1β and RR, pulse and GCS in case of MDA. Regarding biochemical investigations there were significant statistical differences between level of IL-1β and sodium, potassium, troponin I and serum creatinine. And level of MDA & serum amylase, sodium, potassium, troponin I and serum creatinine and platelet level. Regarding ECG and Echo there were significant statistical differences in both levels of IL-1β and MDA.
Regarding cardiac abnormality, in the form of abnormality in one or more of ECG &Echo or troponin I parameters, there were significant statistical differences with both levels of IL-1β and MDA.
In our study, troponin I was abnormal (elevated) in 55.6%, of cases with mean ±SD of 75.9±98.1ng/ml.
Regarding pancreatic abnormality, in the form of one or both of serum amylase & random blood sugar parameters abnormality, there were insignificant statistical differences with both levels of IL-1β and MDA.
There was a significant statistical difference between normal &abnormal cardiac function regarding the demographic data except for age.
There were significant statistical differences between cardiac function, blood pressure (SBP, DBP) & GCS points.
There was a significant statistical difference between cardiac function & clinical presentation (Nausea & vomiting, Abdominal pain, Headache and Trunkal hyperthermia) at time of admission.
There were insignificant statistical differences between normal and abnormal cardiac function regarding the biochemical investigations except for Na + and K+.
There were significant statistical differences between cardiac function and pancreatic function regarding serum amylase and RBS.
There were significant statistical differences between cardiac function and level of IL-1β, MDA.
There was an insignificant statistical difference between normal and abnormal pancreatic function regarding the demographic data except for the site of sting and delay time. The abnormal pancreatic function was recorded in following percentage of patients according to the site of the sting: UL40.0%, LL 46.7%, trunk13.3%, head 0.0%. The delay time with normal pancreatic function ranged from1.5-8 hours with mean ± SD of 4.3±2.5hours. With abnormal pancreatic function, the delay time ranged from 2.5-11hours with mean ± SD of 6.3±2.9 hours.
There were significant statistical differences between normal and abnormal pancreatic function regarding the clinical presentation and GCS.
There was a significant statistical difference between normal and abnormal pancreatic function regarding K+ level which with normal pancreatic function ranged from 3.1-4.2 mmol/L with mean ± SD of 3.6±0.4 mmol/L. However, with abnormal pancreatic function K+ level ranged from 2.5-3.7 mmol/L with mean ± SD of 3.1±0.3 mmol/L. Regarding CBC, there was significant difference between normal and abnormal pancreatic function regarding platelet count which with normal pancreatic function ranged from 150-450 cell/Cmm with mean ± SD of 252.1±107.8 cell/Cmm. However, with abnormal pancreatic function platelet count ranged from 190-500 cell/Cmm with mean ± SD of 349.5±115.4 cell/Cmm.
There were significant statistical differences between pancreatic function and cardiac parameters and its function.
There was a significant statistical difference between pancreatic function with IL-1β and MDA.
By statistical analysis and ROC curve calculation, this study can detect the following data:
The patient with cut off value of IL-1β >50.5 pg/ml will develop cardiac abnormality.
The patient with cut off value of MDA >1.77 nmol/ml will develop cardiac abnormality.
The patient with a cutoff value of IL-1β >50.5 pg/ml will develop ECG abnormality
The patient with a cutoff value of MDA>1.77 nmol/ml, will develop ECG abnormality
The patient with the same cutoff value of IL-1β >78.11 pg/ml will develop echo abnormality
The patient with the same cutoff value of MDA of2.95 nmol/ml will develop echo abnormality.
The patient with a cut off value of IL-1β >81.5 pg/ml will develop troponin I abnormality.
The patient with a cut off value of MDA>2.81 nmol/ml will develop troponin I abnormality.
The patient with cut off value of IL-1β >50.5 of pg/ml will develop pancreatic function abnormality.
The patient with cut off value of MDA>2.54 nmol/ml will develop pancreatic function abnormality.
This study showed that there was a significant increase of IL-1β and MDA in association with cardiac and pancreatic dysfunction related to scorpion venom. This supports the use of antioxidant and (IL-1β) receptor blockers in treatment of scorpion envenomation.
Conclusion
This study demonstrates that scorpion envenomation common in tropical and subtropical zones, and may lead to development of cardiac and pancreatic complications which are a major and serious complications. This study showed that there was a significant increase of IL-1β and MDA in association with cardiac and pancreatic dysfunction related to scorpion venom. This supports the use of antioxidant and (IL-1β) receptor blockers in treatment of scorpion envenomation which should be investigated in further studies.