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

Adipocytokines in pre-pubertal children with type 1 diabetes: relation to some risk factors

Adipose tissue represents an active endocrine organ secreting a variety of factors that regulate energy metabolism and insulin sensitivity. The aim of this study is to evaluate adipocytokines in pre-pubertal children with type I diabetes mellitus and its relation to some risk factors. The study included 20 cases newly diagnosed with type 1 diabetes, 30 cases with long duration of diabetes, and 20 healthy matching children as controls. Cases and controls were subjected to full history taking and physical examination, estimation of BMI, blood glucose level and glycated hemoglobin. Non fasting blood samples were withdrawn from all cases and controls for estimation of serum adiponectin, resistin, leptin, TNF-alpha and IL-6. Results showed that newly diagnosed cases with type I diabetes had significantly lower BMI, serum adiponectin, and serum leptin levels and had significantly higher levels of TNf-alpha and lL-6 than cases with long duration of diabetes. No significant difference in resistin levels was observed between either studied cases or controls. Significant negative correlations were found between adiponectin with both lL-6 and TNF alpha serum levels in the whole studied cases. Also a positive correlation was found between resistin levels and duration of illness. In conclusion adipocytokines may play a role in metabolic adaptation of type I diabetes

Endothelial cell dysfunction and inflammatory process in type 1 diabetic patients with-and without micro vascular disease

Endothelial cell dysfunction results in altered production of cell adhesion molecules [CAMs] that may be involved in the pathogenesis of diabetic microvascular disease. Increased circulating cytokines may also be involved in this process. The aim of the present study was to evaluate levels of some CAMs and cytokines in children and adolescents with type 1 diabetes. It was also aimed to assess these parameters in relation to microvascular complications and certain risk factors. The study included 45 cases with type 1 diabetes aged 8-22 years of whom, 30 cases had evidence of microangiopathy [retinopathy or nephropathy] and 15 cases had not. Fifteen apparently healthy matchable subjects were included as controls. Cases were subjected to full history taking and physical examination. Direct ophthalmoscopy and fluorescein angiography were used to diagnose retinopathy, while nephropathy was diagnosed by detection of microalbuminuria. Level of glycated hemoglobin [HbA[1c]] and serum levels of sVCAM-1 and sE-selectin as well as IL-6 and TNF alpha were assessed for all patients and controls. The results showed that diabetic patients as a whole had significantly higher serum levels of sVCAM-lt sE-selectin, IL-6 and TNF alpha than controls. Post pubertal age, long duration of illness, obesity and high HbA[1c] level were significant risk factors for higher levels of CAMs. Significant positive correlations were found between levels of HbA[1c] and each of serum levels of sE-selectin and IL-6. Also significant positive correlations were found between each of serum levels of sVCAM-1 and sE-selectin, and IL-6 and TNF alpha. Patients with evidence of microangiopathy had significantly higher level of sVCAM-1 than cases without, and the latter group had significantly higher level of sE-selectin than controls. It is concluded that young patients with type 1 diabetes had significant markers of endothelial cell dysfunction particularly in those with microvascular disease. Screening of diabetic patients with E-selectin may help early diagnosis of endothelial dysfunction. Strict glycemic control and new therapeutic targets are mandatory to improve diabetic outcome in such cases

Neuron specific enolase in infants and children with simple and complex febrile seizures

Febrile convulsions are the commonest acute neurological disorder of early childhood. Although febrile seizures seldom cause severe brain insult, it has been recently suggested that febrile seizures can cause hippocampal damage and subsequent mesial temporal lobe epilepsy. This study was conducted to evaluate the serum and CSF levels of neuron specific enolase [NSE] as a marker of neuronal damage and lactate dehydrogenase [LDH] as a marker of metabolic derangement in infants and children with simple febrile seizures [n = 12], complex febrile seizures [n =36], and epilepsy [n =12]. All cases were subjected to full history taking and physical examination. Simultaneous serum and CSF sampling were done on admission for assessment of serum and CSF NSE and LDH levels. Results showed that patients with complex febrile seizures had significantly higher levels of serum and CSF NSE and LDH than cases with simple febrile seizures, whereas they had significantly lower levels of serum and CSF NSE than cases with epilepsy. Correlation studies showed significant negative correlation between age of the patients and serum and CSF levels of NSE in patients with complex febrile seizures, while significant positive correlation was found between duration of seizures and serum levels of LDH and between number of seizures and serum NSE levels in cases with complex febrile seizures. It is concluded from this study that complex febrile seizures are more injurious to the neurons than cases with simple febrile seizures especially in younger age group. Prompt diagnosis and guided management is recommended in such cases. NSE maybe a useful test for assessment of neuronal damage after febrile seizures

Transforming growth factor beta and other angiogenic factors in hematologic malignancies of childhood

Angiogenesis, a process of new blood vessels formation from an existing vasculature, has been blamed for growth, dissimination and metastasis of solid tumors. Little is known about angiogenesis and angiogenesis- related molecules in hematologic malignancies. Transforming growth factor-beta [TGF- beta] and platelet-derived growth factor-C [PDGF-C] are considered as indirect angiogenic factors in tumorigenesis. Gangliosides and hyaluronan are components of cell membrane that modulate cell membrane signal transduction of multiple growth factors. The aim of this study is to assess serum levels of TGF- beta, PDGF-C, Gangliosides, and hyaluronan in children with newly diagnosed malignancies including 15 cases with acute lymphoblastic leukemia [ALL], 15 cases with non Hodgkin lymphoma [NHL], and 10 cases with neuroblastoma. Ten matchable apparently healthy children were included as controls. Results of the study showed that cases as a whole had significantly higher levels of TGF-beta, PDGF-C, gangliosides and hyaluronan than controls. Furthermore cases with hematologic malignancies as well as those with neuroblastoma had significantly higher levels of the studied parameters than controls. On comparing the different groups of cases with each other, it was found that cases with ALL and NHL had significantly higher level of TGF-beta than cases with neuroblastoma whereas the latter group had significantly higher level of gangliosides than ALL and NHL groups and higher level of hyaluronan than ALL group. Cases of NHL and neuroblastoma with advanced disease had significantly higher levels of the studied parameters than the rest of cases. In conclusion the angiogeneic factors TGF-beta, PDGF-C, gangliosides, and hyaluronan are raised in children with ALL and NHL as well as in those with neuroblastoma. Their levels are significantly higher in severer cases with advanced stages of malignancy. The estimation of their levels therefore not only points to the severity but also help to predict progress in these cases

Influence of zinc supplementation on thyroid function and intelligence in children with down syndrome

This study was conducted to evaluate some factors that may affect the cognitive abilities of children with Down syndrome [DS] including hypothyroidism; zinc and selenium deficiency; and the oxidative five stress and additionally, to study the effect of zinc supplementation on the mental state of such cases. Sixty Down syndrome patients were enrolled together with 20 apparently healthy controls with matched age and sex. Estimation of the IQ scores, evaluation of the thyroid function tests, measurement of the serum levels of zinc and selenium, as well as plasma levels of superoxide dismutase activity [SOD] and hydrogen peroxide [H[2][O]2] were done to all cases and controls, Cases with severe mental retardation [IQ 25-39] were received oral zinc sulfate supplementation. A follow up study was done to reevaluate all the above-mentioned studied parameters after 3, and 6 months. Results showed that, in comparison with the controls, DS patients had significantly lower serum levels of both zinc and selenium and significantly higher serum level of TSH, as well as plasma levels of both SOD and H[2]O[2]. There were significant positive correlations between the IQ scores and each of T3, T[4], zinc and selenium serum levels, while significant negative correlations were found between the IQ scores and serum level of TSH, as well as plasma levels of both SOD and H[2]O[2]. The follow up study showed significant rise of serum zinc level after 3 months of zinc supplementation. Progressive improvement of the IQ scores and thyroid function tests were noticed. This improvement was significant after 6 months of zinc supplementation. In conclusion, cognitive abilities in DS patients may be affected by multiple factors as hypothyroidism, oxidative stress as well as zinc and selenium deficiency. Zinc supplementation for 6 mo may help these abilities to be improved