RESUMO
Our study was conducted on 81 high risk newborns 35 preterm, 46 fullterms] in addition to 20 healthy newborns [9 preterms, 11 fullterms] as a control group matched with study group. Anthropometric measurements [weight, length and head circumference] vital signs [heart rate, systolic blood pressure, respiratory rate and temperature]. Radiological investigations were done for all cases and controls including transcranial sonar, brain CT, and transcranial Doppler studies of internal carotid artery, middle cerebral artery and anterior cerebral artery for mean velocity, pulsatility index and resistive index. The group of CNS congenital anomalies showed significantly lower birth weight and significantly bigger head circumference. The group of preterms with meningitis showed significantly bigger head circumference. The group of preterms with HIE and the group of fullterms with meningitis showed significantly lower HR. The groups of HIE [preterms and fullterms] as well as complicated LBW showed significantly higher RR than controls. Higher percentage of abnormalities was observed by CT than by transcranial sonar. IVH and PVE were found only in preterms, PVE was not seen by CT while lVH and ventricular dilatation were equally seen by sonar and CT Brain oedema was over diagnosed by sonar than by CT. Other lesions including cortical damage, WMH, meningeal enhancement and subarachnoid hemorrhage were seen only by CT. Lower birth weight in preterms [<1220 gm] was significantly associated with higher frequency of abnormal sonar and abnormal CT and IVH, also Lower birth weight in fullterms [<2750 gm] was significantly associated with higher frequency of abnormal CT and ventricular dilation. Bradycardia [HR <120/m] was significantly associated with significantly higher frequency of abnormal sonar and abnormal CT in our high risk newborns [prerterms and fullterms] particularly significantly higher frequency of IVH in preterms and WMH in fullterms. Hypotension in preterms [B.P. <45mmHg] was significantly associated with significantly higher frequency of abnormal sonar and abnormal CT, lVH and PVE, also hypotension in fullterms [B.P. <50mmHg] was significantly associated with higher frequency of abnormal CT and WMH. Transcranial Doppler findings revealed higher mean velocity and lower PI and RI in preterms and fullterms with HIE and meningitis than controls. Also lower MV and higher PI and RI than controls. ln preterms and fullterms with bradycardia we observed higher MV and lower PI and RI. In preterms and fullterms with hypotension, we observed lower MV and higher PI and RI. Significant -ve correlations were observed between MV and HR, also significant +ve correlations were observed between PI as well as RI and HR
Conclusion: transcranial sonar is very helpful in diagnosis or various CNS affection in high risk newborns particularly in complicated LBW, HIE, meningitis and CNS congenital anomalies. Higher rates of abnormalities both by transcranial sonar and CT were observed in relation to bradycardia and hypotension. The use of transcranial Doppler may not reflect a specific disease entity because it could be affected by other different factors
RESUMO
In the present study, thirty scorpion envenomed children [less than 12 years old] were compared with twenty healthy children of matched age as a control group. Full clinical examination, a complete blood picture; arterial gases and serum cytokines were determined in all cases. The serum levels of interleukin-6 [IL-6], soluble IL-6 receptor [sIL-6R], regulated on activation normal T cells expressed and secreted [RANTEs] and tumour necrosis factor-alpha [TNF-alpha] were estimated once for the controls and twice for the victims, the first sample on admission and the second sample after 24 hours. All victims showed significantly higher mean values of IL-6, sIL-6R, RANTEs, TNF- alpha, and leucocytic count both on admission and on the follow up when compared with controls. According to the clinical manifestations of envenomation, 40% of the victims [12 victims] had a mild envenomation manifestation, while 60% of them [18 victims] had severe manifestations. The severely envenomed children showed significantly higher mean values of IL-6, sIL-6R, TNF-alpha, RANTEs and leucocytic count both on admission and on the follow up samples when compared with the mild cases. The non-survival victims [3 victims] showed significantly higher mean values of IL-6, sIL-6R, TNF - alpha, RANTEs and leucocytic count both on admission and on the follow up samples in comparison to the survivals. Furthermore, those fatal cases showed a non-significant decline in the serum levels of IL-6, sIL-6R, TNF-alpha, RANTEs and leucocytic count on the following up samples, while the survivals showed a significant decline in the serum levels of these parameters on the following up samples. In conclusion, these data revealed that cytokines are involved in the pathogenesis of scorpion envenomation and correlated with its severity