Clinical characteristics and outcome of children stung by scorpion referred to Assiut University Children Hospital

Scorpion envenomation continues to be a health problem in tropical and subtropical regions particularly among children. The aim of this study was to evaluate demographic and clinical characteristics as well as outcomes in referred children to Assiut University Children Hospital during the year 2010 with history of scorpion sting, and to describe features that may be associated with poor outcome. The medical files of these cases were reviewed retrospectively for demographic data, time and site of singing, and clinical presentation with recording of local reaction and systemic manifestations especially neurological, cardiopulmonary and gastrointestinal manifestations. According to Abrougs clinical severity classification, cases were divided into three classes of severity. Laboratory investigations of the cases were reviewed for CBC, blood urea nitrogen, liver function tests, creatinine phosphokinase [CPK], lactate dehydrogenase [LDH], arterial blood gases and serum electrolytes including sodium, potassium, and calcium. Referral to the ICU, connection to mechanical ventilation and death were also recorded. Results showed that 111 children presented to the Emergency Unit with history of scorpion sting; 69 males and 42 females with the mean age was 6.1 +/- 3.5 years [range 1-16 years]. Out of the studied cases, 53.2% were classified as class III of clinical severity with recorded pulmonary edema in 33.3%, cardiogenic shock in 46.8% and severe neurological manifestations in 22.8%. Connection to mechanical ventilation was recorded in 25.2%. Twelve cases [10.8%] were classified as class II with mild systemic manifestations, and 36% of cases were classified as class I with only local reaction. Outcome of these cases were discharge without sequelae in 55.8%, discharge with sequelae in 26.1% and death in 18.1%. Stung children with scorpion who died were significantly presented with lower GCS, pulmonary edema and cardiogenic shock than cases who survived. Regarding laboratory studies, died cases showed significantly higher levels of total leukocytic count, blood glucose level, serum sodium level, CPK and LDH than cases who survived. In conclusion more than half of stung children with scorpion suffered severe clinical presentation and about one fifth died. Aggressive treatment regimens are recommended for such cases to improve the outcome

Evaluation of homocysteine level in children with cerebrovascular stroke

Cerebrovascular stroke is an important cause of morbidity and mortality in children. Recent epidemiologic data suggest that 3200 cases of stroke occur per year in the population aged between 30 days and 18 years in the US alone. Although outcome for stroke in children is significantly better than in adults, 20% die and 50%to 80% are left with significant disability. Moderately elevated homocysteine status is considered an independent risk factor for occlusive arterial disease in the peripheral arteries and cerebral vessels. Higher homocysteine levels could cause either isehemic stroke by it s procoagulative effects and induces endothelial damage or hemorrhagic stroke by promoting vascular inflammation and plaque rupture. To evaluate the role of homocysteine as a risk factor of cerebrovascular stroke in children. The study was conducted in intensive care and emergency units in Pediatric Assiut University Hospital during the period between October 2005 and September 2006 and included 52 children with stroke [65.4%ischemic and 34.6% hemorrhagic] and contained 34 boys and 18 girls, aged 30 days to 4.5 years after exclusion of stroke due to trauma and tumor as vell as 20 apparently healthy children with matchable age and sex as control group. All cases were evaluated by Pediatric National Institute of Health Stroke Scale on admission as a measure of stroke severity, besides meticulous history taking and thorough clinical examination. Evaluation of plasma levels of homocysteine, random blood glucose, serum sodium and potassium were done for all cases and controls. The annual frequency rate of stroke was 0.3%. The mean +/- SD of random blood glucose was significantly higher in children with ischemic compared to hemorrhagic stroke and in both compared to control. The mean +/- SD of serum sodium was significantly higher in ischemc compared to hemorrhagic and control groups. The mean +/- SD of serum potassium was significantly lower in ischemic and hemorrhagic stroke compared to control The mean +/- SD of homocysteine in children with ischemic and hemorrhagic strokes were more than control group with a statistical significant difference while, no statistical significant difference was detected between the two groups. The odds ratio of homocysteine for ischemic and hemorrhagic stroke were [3.3, CI 2.38-26.9] and [1.9, CI 2.3-46.8] respectively. The mean +/- SD of homocysteine was significantly higher in children with hospital stay more than 2 weeks, in children with PedNIHSS >/= 12 and in non survivors. Hyperhomocysteinemia is significant risk factor of stroke in children