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At least 73 records · Page 4Linked to original sources
PubMed1999

Serotherapy in scorpion envenomation: a randomised controlled trial.

BACKGROUND: Evidence for the benefit of scorpion antivenom, the only specific treatment for scorpion envenomation, is scarce, despite its common use. We did a prospective, randomised, controlled trial to assess the efficacy of routine administration of scorpion antivenom to scorpion-stung patients, irrespective of clinical severity. METHODS: We included 825 consecutive patients older than 10 years, who presented to the accident and emergency department of the hospital in Tozeur, Tunisia. We graded severity by absence (grade I) or presence (grade II) of systemic manifestations of scorpion envenomation. Patients were randomly assigned placebo (n=413) or 20 mL bivalent intraveneous scorpion antivenom (n=412). All patients were observed for 4 h. Patients who developed life-threatening symptoms were admitted to the intensive-care unit. At the end of 4 h observation we reassessed grade and discharged grade II patients and admitted grade II patients. We assessed the preventive and curative effects of scorpion antivenom by prevention of worsening grade or by improvement from grade II to grade I. FINDINGS: Distribution of severity grades was similar in the two groups at baseline, as were the cure rates (55% scorpion antivenom, 66% placebo, absolute difference, 11% [95% CI -4.8 to 26.8]; p=0.234). Preventive effects were seen in 94% and 96% of patients in the scorpion antivenom and placebo groups, respectively, who were initially grade I and who remained symptom-free (absolute difference, 2% [-1.27 to 5.27]; p=0.377). Time from scorpion sting to administration of scorpion antivenom did not affect curative and preventive effects. INTERPRETATION: We found no benefit in routine administration of scorpion antivenom after scorpion sting, irrespective of clinical severity. Future studies should focus on patients with the most severe symptoms and signs.

Adolescent↗
PubMed2003

Treatment of the scorpion envenoming syndrome: 12-years experience with serotherapy.

The pathophysiology of the scorpion envenoming syndrome is described with emphasis on the body systems commonly affected. Concepts of the mechanisms underlying venom action, as can be explained by the recently discovered effects on ionic channels, are discussed. A protocol for the treatment of scorpion stings based mainly on antivenom therapy was applied nationwide in Saudi Arabia. A list of drugs with alternatives was specified to be used in adjunctive therapy, when required. Analysis of the outcome from 1,033 cases at Al-Baha region, 791 cases at Al-Qassim region and more than 2,000 cases from 12 central and specialist hospitals in the Central Province, Saudi Arabia gave impressive results. The incidence of severe venom toxicity following antivenom administration was almost negligible. The period of stay in the hospital was reduced. The early reaction to antivenom administration was lower than expected the severity of the reaction consisting mainly of skin rashes, urticaria, wheezing and bronchial hypersensitivity, but no anaphylaxis. About 13.8% of the victims had been previously treated with antivenom but only 1.7% of the patients showed positive skin tests. This might be due to the low protein content of the antivenom and the action of the venom in releasing massive amounts of catecholamines.

Analgesics, Non-Narcotic↗
PubMed1980

Influence of C. parvum on the effectiveness of passive serotherapy in the control of the EL4 lymphoma in C57BL/6 mice.

Administration of C. parvum alone did not improve the survival of C57BL/6 mice injected with the EL4 lymphoma. The anti-tumour effect of anti-EL4 Ig was however increased by C. parvum treatment, and the combination therapy of anti-EL4 Ig and cytotoxic drugs was even more improved. However, C. parvum only had this effect when given by the same i.p. route as the tumour cells, and the effect was greater when C. parvum was injected 5 days before than 1 day after tumour cells.

Animals↗
PubMed1994

Serotherapy in the management of scorpion sting in children in Saudi Arabia.

A total of 780 children with scorpion stings were admitted to a referral hospital in Saudi Arabia over a 7-year period. A similar number was managed in the outpatient department. The mortality was 4.8% initially, but no death occurred in the last 2 years of the study period. The reduction in mortality is attributed to the use of antivenom and improvement in case management.

Adolescent↗
PubMed1999

Efficacy of serotherapy in scorpion sting: a matched-pair study.

BACKGROUND/OBJECTIVE: Although evidence of scorpion antivenin effectiveness in the clinical setting is lacking, scorpion antivenin is generally considered the only specific treatment for scorpion sting irrespective of its clinical severity. We conducted a matched-pair study to assess the efficacy of systematic administration of scorpion antivenin. METHODS: Among 600 stung patients who participated in a study on the efficacy of high-dose hydrocortisone after scorpion sting, 135 (cases) had been treated with 10 to 20 mL intravenous scorpion antivenin (neutralizing 10 LD50 venom/mL). Controls were matched on disease severity on arrival to the emergency department. The severity of envenomation was graded I or II according to the absence (grade I) or the presence (grade II) of systemic manifestations of scorpion envenomation. Assessment of scorpion antivenin efficacy was based on the rate of changing severity grade in both groups (clinical improvement or worsening during an observation period of at least 4 hours). RESULTS: Both groups were similar with respect to clinical severity (36 patients were graded II in each group), age, sex, time-lapse between scorpion sting and ED arrival, and the administration of adjunctive therapy such as hydrocortisone. By the 4-hour evaluation, 50% and 64% of patients initially graded II exhibited a substantial clinical improvement in cases and controls, respectively, suggesting similar effects in cases and controls. There was no difference in preventive effects: 13% and 10% of cases and controls developed systemic manifestations of scorpion envenomation during the 4-hour observation period; 23% of cases and 17% controls were hospitalized by this time. There was no difference in the duration of hospitalization. Three cases developed anaphylactic shock as a consequence of scorpion antivenin administration, while 1 scorpion antivenin-untreated patient died from refractory shock. CONCLUSION: Systematic administration of scorpion antivenin irrespective of clinical severity did not alter the clinical course of scorpion sting. A prospective study is needed concerning the response of the more severe scorpion envenomations.

Adolescent↗
PubMed1986

Tolerance to rat monoclonal antibodies. Implications for serotherapy.

The antiglobulin response is a major complication of mAb therapy. It has been suggested that, in clinical practice, this might be avoided by using human or chimeric mAbs, or by prior induction of tolerance to the therapeutic mAb. In this study, we show that it is possible to induce tolerance in mice to the constant regions of rat IgG2b mAbs by both classical deaggregation methods and by anti-L3T4 mAb therapy. Mice tolerant to IgG2b constant region determinants failed to make an antiglobulin response when immunized with a number of mAbs of the same isotype that had no binding specificity for mouse cells, but produced vigorous antiidiotypic responses to cell-binding mAbs. Binding of antibodies to hemopoietic cells rends their idiotypic determinants major immunogens even in the presence of tolerance to constant region epitopes. These findings suggest that the use of human or chimeric mAbs will not be sufficient to eliminate the antiglobulin response, and that additional methods need to be investigated.

Animals↗
PubMed2001

From bench to bedside: discovering rules for antibody design, and improving serotherapy with monoclonal antibodies.

Anti-T-cell monoclonal antibodies (mAbs) form a unique class of therapeutic agent. Their precise specificity offers tremendous potential for the treatment of autoimmune and inflammatory diseases but also prevents meaningful preclinical animal studies. In particular, adverse reactions to therapy may be unanticipated, and the first administration of a novel T-cell mAb to a patient thus marks the beginning of a unique experiment. By comparing clinical parameters and laboratory measurements, small-scale pilot studies can provide detailed information about mAb biology that both predicts and suggests solutions to the complications of therapy. In this essay I illustrate this concept with reference to three specific areas: lymphocyte depletion, mAb immunogenicity and cytokine-release syndromes. In each case, systematic clinical and laboratory science has improved our understanding of the problem and suggested solutions; most of these solutions have been or are being adopted. Thus, small, open studies are an essential step in the development of novel mAbs, provide an ideal platform for the study of mAb biology, and serve as an early warning system for potential adverse effects.

Animals↗
PubMed1986

Suppression of B cell immunity to DNP by serotherapy with monoclonal anti-DNP antibodies. Effect of the treatment schedule on the magnitude of specific suppression and its duration.

The effect of prior administration of anti-DNP (N-[2,4-dinitrophenyl]-B-alanylglycylglycine) monoclonal antibodies on the humoral immune response of BALB/c mice was examined. One-time administration of a "cocktail" of two anti-DNP monoclonals resulted in suppression of the IgM anti-DNP response for one week after challenge but not longer. Maximal suppression of anti-DNP IgM plaque-forming cells was achieved by administration of antibody 1-2 weeks before challenge with DNP. Maximal suppression of serum IgM antibody was seen by administration of antibody 2-3 weeks before challenge with antigen. Following one-time administration of suppressive monoclonal antibody, the serum IgG antibody response to DNP was suppressed beginning 2 weeks after immunization and remained so for up to 241 days despite continual booster injections of antigen. Although most effective suppression of the humoral anti-DNP response was seen in animals receiving their single dose of suppressive antibody 2 weeks before first exposure to antigen, suppression of the IgG response was evident at all intervals examined up to 232 days in mice given monoclonal antibody between 0.1 day and 30 days before antigen, but not at earlier times. These findings suggest that regulatory networks, rather than the masking of antigenic determinants by passively administered antibody, play a role in antibody-mediated immunoregulation. They may be of use in designing strategies for optimizing immunosuppression protocols in clinical studies.

Animals↗
PubMed1979

Intrathecal serotherapy in neonatal tetanus: a controlled trial.

60 infants with neonatal tetanus were treated at random either by 40 000 units of equine tetanus antitoxin (TAT), intravenously and intramuscularly, or by 40 000 units TAT, IV and IM, plus 150 units of human tetanus immune globulin TIG) intrathecally. There were 30 infants in each treatment group. Babies were similar in age, sex, weight, incubation period, temperature, and signs and symptoms on arrival at the hospital. The mortality rate, days in hospital and days of sedation were not significantly different in the two groups.

Clinical Trials as Topic↗
PubMed1998

Second degree atrio-ventricular block and cardiotoxicity secondary to envenomation by the scorpion Leiurus quinquestriatus ('yellow scorpion')--an indication for serotherapy?

Tachyarrhythmia following scorpion envenomation might be an indication for anti venin therapy. We present a case of an unusual cardiotoxic response to Leiurus quinquestriatus ('yellow scorpion') venom-second degree atrio-ventricular block (Mobitz type 1). We review the biological activities of L. quinquestriatus' venom and the arrhythmia's possible pathophysiology. The question arising from this case is the therapeutic approach to cardiotoxicity and bradyarrhythmias induced by scorpion envenomation-mainly, the indication for anti serum therapy.

Adult↗