Evaluation of Risk Factors and Follow-Up Criteria for Severity of Snakebite in Children.

BACKGROUND: Snakebites are an emergency medical condition and require rapid treatment procedures in children. OBJECTIVES: This study aimed to present an overview of the demographic characteristics, clinical presentations, laboratory findings, severity, and complications that developed in pediatric patients due to snakebites. PATIENTS AND METHODS: A total of 151 children with snakebite were enrolled in the study. All patients had a history of snakebite obtained between June 2006 and August 2015 retrospectively. RESULTS: Duration of hospitalization (P < 0.001), rural occurrence (P < 0.001), white blood cell (WBC) count (P = 0.002), aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio (P = 0.010), hypoproteinemia (P = 0.001), hypoalbuminemia (P < 0.001), and hypocalcemia (P = 0.005) were significantly high in the severe snakebite group. WBC (P = 0.006) and AST/ALT ratio (P = 0.018) were significantly higher on the first day of the snakebite than on subsequent days. CONCLUSIONS: Children admitted to the hospital due to snakebite should be monitored for at least 24 - 48 hours even if no signs of clinical envenomation could be observed. According to the severity of the disease, antivenom should be administered to the patients. Duration of hospitalization, rural occurrence, WBC count, AST/ALT ratio, CK, hypoproteinemia, hypoalbuminemia, and hypocalcemia can be associated with the severity of snakebite. WBC AST/ALT ratio can be used as follow-up criteria in children with snakebite.

Primary repair of the alveolar cleft.

Nasoalveolar fistula and oropharyngeal fistula of the anterior palatal region are very commonly seen in cases when there are concomitant clefts of the lip and the palate. Absence of adequate tissue in that region complicates the treatment and necessitates new tissue transfers from near or distant tissues. Today, the techniques used for correcting cleft lip cannot successfully solve these 2 problems. In this study, we describe a technique that depends on the principle of using the lip mucosal tissues that remains during the Tennison cleft lip correction technique, with a flap designation, to correct the tissue defect of the cleft between the foramen incisivum and lip and the alveolar region. Twenty-two patients (13 boys and 9 girls), with ages ranging from 3 to 53 months (mean, 24 mo), with unilateral cleft lip and palate underwent surgery with this new technique. In all these patients, clefts in the anterior palatal and alveolar regions were successfully corrected. Fistula was observed in none of these patients in these regions. Through this method, clefts in the anterior palatal and alveolar regions can be corrected during repair of cleft lips.