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
Résumé
The current prospective clinical trial study included 60 cases [39 males and 21 females] of acute meningitis admitted to the pediatric department, Assiut University Hospital during the period from September 2000 to August 2001. Their age ranged from 3 months to 8 years. All cases were subjected to complete history and clinical examination. The following routine laboratory investigations were done on admission: chemical, cytological and bacteriological examination of the cerebrospinai fluid [CSF], blood picture, C-reactive protein [CRP], renal function test, serum electrolytes [Na, Ca, K], parameters of coagulation prohle, tuberculin test, stomach wash for tubercle bacilli, chest X-ray, tibrinogen degradation product [FDP], and arterial blood gases. According to the presenting age, the cases were classified into 3 age groups: first group [38 cases]: aged 3 months to 1 year to 5 years to 8 years. According to the antibiotic treatment protocol, the patients were randomly classified into two groups: 30 cases received crystalline penicillin and cefotaxime while the other 30 cases received chloramphenicol and ampicillin. Out of the 60 studied cases, 37 were treated with dexamethasone as adjunctive therapy for 48 hours. Bacteriological and hematological monitoring parameters were reevaluated for the studied cases till discharge or death. All the survivors were screened for hearing loss by measuring auditory brain stem response [ABR]. The results showed that the incidence of meningitis was higher during winter months. Out of the 60 studied cases, 31.9% had haemophilus influenzae B [Hib], 23.4% had streptococcus pneumoniae [St. pn] and 18.3 % had Nesseria meningitides in the CSF film and culture, while 26.6 % were considered as aseptic meningitis after exclusion of TB. In the youngest age group, Hib was the dominant pathogen. The clinical manifestations of meningitis differed according to the age, but not according to the causative organism. The outcome of cases did not significantly differ according to the type of antibiotic protocol used in the study. Out of the 60 studied cases, 20% died, while 36.1% had complete recovery, and 43.3% recovered with neurological sequelae. The best cure rate was in cases of Hib meningitis [58%], while N. mengititides infection was associated with significantly higher incidence of mortality [72.7%] and cases with St. pn had higher incidence of neurological complications [72%]. Hearing loss was detected in 40% of survivors. The addition of dexamethasone to the treatment protocol was associated with significant reduction in the incidence of hearing loss especially among those infected with Hib. The risk factors for hearing loss and fatal outcome were: seizures on admission, impaired level of consiousness, change in muscle tone, raised FDP, low prothrombin concentration and N. meningitides as causative organism
Conclusion: Acute bacterial meningitis is a real health problem in Upper Egypt, and is still associated with a high incidence of mortality and morbidity. Vaccination against Hib and N. meningitides should be carried out to decrease the incidence of meningitis. The addition of steroid as adjuvant therapy could be of value in reducing the development of hearing loss. Further studies on bigger number of cases are needed to validate the risk factors detected in this study