ABSTRACT
Objectives: We sought to review the management of scorpion stings in tertiary and secondary care emergency departments in Oman and determine physician's knowledge of management protocols
Methods: We conducted a retrospective study of all scorpion stings cases seen in Sultan Qaboos University Hospital [SQUH] emergency department [ED] from March 2016 to July 2017. Additionally, we conducted a survey of ED physicians regarding their management of scorpion stings in three different EDs including SQUH
Results: The total number of scorpion stings seen at SQUH during the study period was 128. Localized pain was seen in 97.7% [n = 125], swelling in 14.8% [n = 19], and local redness in 7.0% [n = 9] of patients. Around 13.0% [n = 17] of patients were found to have systemic symptoms with tachycardia being the most common. Bedside clotting test was done for 11.7% [n = 15] of patients. The most commonly used treatment was local anesthesia [54.7%, n = 70]. No patient received scorpion antivenom. In the 89 surveyed physicians the main management method used was analgesia [88.8%, n = 71] followed by local anesthesia [81.1%, n = 65]. Most physicians [80.0%, n = 64] believed that local anesthesia was the most effective management. However, 32.5% [n = 26] ordered a whole blood bedside clotting test, 69.2% [n = 18] of which were junior doctors
Conclusions: Most scorpion sting cases managed in SQUH had local symptoms. Tachycardia was the most common systemic manifestation. Bedside clotting test was not commonly ordered and mainly requested by junior doctors. Local anesthesia infiltration is the recommended management for scorpion sting. Analgesia was the main management followed by local anesthesia
ABSTRACT
This study investigates the in vitro effect of the antioxidant drug, N-acetyl-L-cysteine [NAC], on cytokine production by peripheral blood mononuclear cells [PBMC]. PBMC were isolated by Ficoll-Hypaque, and stimulated with anti-CD3 antibodies, phytohaemagglutinin [PHA], lipopolysaccharide [LPS] for 24 hours in the presence or absence of 5 mM NAC. The cytokines produced were measured by enzyme-linked immunosorbent assay [ELISA]. Treatment with NAC significantly up-regulates the secretion of IL-1beta, IL-5 [interleukin] and IFN-gamma [interferon] and down regulates IL-10 production, after anti-CD3 or PHA [p<0.05], but not after LPS stimulation. NAC also significantly increased total IL-12 secretion after anti-CD3 [but not PHA or LPS] stimulation and IL-12p40 after anti-CD3, PHA, and LPS stimulation [p<0.05]. These results indicate that NAC up-regulated the production of pro-inflammatory cytokines, and down regulated anti-inflammatory cytokine production by PBMC, in a process which may be associated with increased levels of glutathione [GSH]. Further work is required to determine whether this increase or decrease in cytokine production is due to direct effect of NAC