Résumé
The present study included 46 victims of scorpion envenomation aged 2-13 years, admitted to pediatric department, Assuit University Hospital, during the summer months of 2002. Another 20 apparently healthy children of matchable age and sex were considered as controls. Out of the studied victims, 25 showed signs of severe envenomation and Multiple Organ Dysfunction [MOD] as hypotension, pulmonary edema, myocarditis, dissiminated intravasular coagulopathy [DIC], toxic encephalopathy, persistent hypoxia and acidosis and need for mechanical ventilation and were admitted to ICU, while 21 cases showed signs of mild envenomation. In addition to the routine monitoring investigations, the following investigations were done for all patients and controls: Serum levels of soluble Fas [sFas], soluble Fas ligand [sFasL], B cell lymphoma 2 protein [BcI-2], nitric oxide [NO] and lipid peroxide [LPO]. Scoring of MOD was done according to the Logistic Organ Dysfunction System [LODS] score of Le Gall et al, [1996] for the severely envenomed victims. Results showed that sFasL was not detectable in the sera of the healthy control group. All the studied patients showed significant higher mean values of sFas, LPG and NO in comparison to the control group. On the other hand, serum levels of Bcl-2 were significantly lower in all the included victims in comparison to the control group. Moreover, the severely envenomated subjects with MOD as well as the non survivors showed significantly higher mean values of the previous laboratory parameters [sFas, sFasL, LPG and NO] and lower mean values of Bcl-2 in comparison to the mild envenomated victims and the survivors. Case fatality rate in this study is 15.2%. The LODS score of the victims with MOD showed significant positive correlations with each of sFas, NO, LPG, and a significant negative correlation with serum values of Bcl-2. Serum values of sFas had significant positive correlation with NO and negative correlation with BcI-2
Conclusion: The previous results suggest the presence of a positive association between circulating apoptotic marker [sFas], the apoptosis signaling LPG and NO and the severity of scorpion envenomation and MOD score. 0n the other hand, a negative correlation was found between the severity of envenomation and the anti-apoptosis marker Bcl-2. So that. sFas and BcI-2 could be of value in predicting the outcome of these cases. This may throw some light on the management of these cases through modulation of apoptosis, whether by protecting the anti-apoptosis BcI-2 or by inhibiting sFas production; a point that needs further exploring studies