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

Pulmonary hypertension in thalassemic children: does endothelial dysfunction play a role?

The thalassemia syndromes are a heterogeneous group of inherited hemoglobin disorders resulting from impaired production of either the alpha or beta globin chain subunits of the hemoglobin tetramer. Heart failure is the most common cause of death in thalassemia. Thalassemic heart disease involves mainly left ventricular dysfunction caused by transfusion- induced iron overload. However, recent studies suggest that TM patients have a unique hemodynamic pattern consistent with right ventricular cardiomyopathy, and pulmonary hypertension in addition to the LV abnormalities. Pulmonary hypertension in beta-thalassemia could represent a common, yet less well-explored complication in the cardiopulmonary spectrum of the disease. The aim of this study is to determine serum levels of cholesterol, triglycerides, nitric oxide [NO], endothelin-1 [ET-1], lnterlukin-6 [lL-6] and the soluble forms of vascular cell adhesion molecule [sVCAM-1] as well as intercellular adhesion molecule [sICAM-1] in transfusion-dependent beta-thalassemia children and to correlate these markers with the echocardiographic findings as well as serum ferritin of these patients. The study included 32 transfusion-dependant children with beta-thalassemia aged 5 to 15 years and 40 apparently healthy children as a control group. Serum levels of cholesterol, triglycerides, NO, ET-1, lL-6 and the soluble forms of vascular cell adhesion molecule [sVCAM-1] as well as intracellular adhesion molecule [sICAM-1] were determined for patients and controls. In addition echocardiography was also done. Serum levels of ET-1, lL-6 and the soluble forms of vascular cell adhesion molecule [sVCAM-1] as well as intracellular adhesion molecule [sICAM-1] were significantly higher in the studied cases than the controls while serum levels of cholesterol and NO were significantly lower. Echocardiographic evidence of pulmonary hypertension was detected in 68.75% of the cases. The lassemic cases with PHT had significantly higher values of ET-1, lL-6, VEGF, sICAM and sVCAM than those without PHT. Pulmonary hypertension in beta-thalassemia could be an additional complication in the cardiopulmonary spectrum of the disease due to NO deficiency as a result of iron overload and endothelial dysfunction. Therapeutic interventions that decrease hemolytic rate, improve, enhance NO effects, or act as NO donors are of potential benefit and may alter the progression of the disorder