BACKGROUND: Scorpion sting envenomation is a common public health problem in Egypt and life-threatening emergency, particularly in children. They are at greater risk of developing severe cardiac, respiratory, and neurological complications. Early evaluation of the severity of the envenomation is essential to institute adequate treatments and prevent mortality. AIM: The aim of this study was to assess the value of some routine biochemical parameters in the prediction of severity of scorpion envenomation among some Egyptian children. METHODS: A prospective observational study was conducted on all scorpion envenomated children, admitted to the poison control centre , Ain shams university hospitals from January to December 2015. On admission, all the children with envenomation were subjected to complete medical history, physical examination and routine biochemical laboratory tests. The patients were classified in to three main groups, according to the degree of severity; Group II (mild grade); Group III (moderate grade) and Group IV (severe grade). In addition, ten apparently healthy children were included as a control group (Group I). RESULTS: there were 25 patients (41.6%) in group II, 20 patients (33.4%) in group III and 15 patients (25%) in group IV. The mean age and body weight were significantly decreased in groups III and IV, being lower in group IV. The mean delay time between sting and hospital admission was significantly longer for group IV compared with group III followed by group II. The frequency of stings in lower limb (68%) was significantly higher than those on the upper limb (32%) in group II. It was significantly higher in upper limb than lower limb in groups III and IV. Clinically, the most common finding was severe pain at sting site in all studied groups. Furthermore, the results of patients in group IV were significantly higher when compared with group III as regards: the general manifestations (sweating, fever and cold extremities); respiratory manifestations (tachypnea, cyanosis and pulmonary edema); cardiac manifestations (hypertension, tachycardia and heart failure); neurological manifestations (agitation and coma) and gastrointestinal manifestations (vomiting and abdominal pain). The mean values of random glucose level, total WBC and platelet counts were significantly higher in groups III and IV when compared with control group, being higher in group IV when compared with group III. The mean values of CK-MB level were significantly higher in group IV when compared with control group. In severe cases (group IV), Platelet counts showed a significant positive correlation with WBC count, and CK-MB level values, In addition WBC count showed a significant positive correlation with CK-MB level. While glucose level showed insignificant correlation with CK-MB level, WBC and platelet counts. The mean duration of hospital stay was significantly longer in group IV compared with groups II and III. All the patients discharged with complete recovery with no morbidity or mortality. CONCLUSION: Increased le...

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Corrosive products ingestions in children pose potentially devastating presentations and lifelong complications which remain one of the most challenging concerns encountered in medical practice. Prompt diagnosis and management are of outmost importance in decreasing mortality and achieving optimal long-term outcomes. Aim of the work: to investigate the predictability of the severity of corrosive poisoning outcome from some clinical findings and laboratory data at presentation. Patients and Methods: The study enrolled children with corrosive substances poisoning admitted to Poison Control Center-Ain Shams University during the period from January 2015 till September 2016. Demographic variables, on admission clinical findings, routine laboratory data and the outcome variables (length of hospital stay, development of stricture and mortality rate) were recorded. Patients were classified into two groups; the non-complicated group and the complicated group. Results: 106 patients, 56 males (52.8%) with median age (3.06±2.57 years) met inclusion criteria. Signs and symptoms as (vomiting, dysphagia, drooling, hematemesis and respiratory distress) were found to be significantly higher in the complicated group as compared to the non-complicated group, while oral lesions and stridor showed insignificant difference between the two groups. Initial vomiting, drooling, dysphagia and hematemesis, but not respiratory distress, exhibited significant correlation with poor outcome (longer hospital stay, developing stricture/stenosis and increased mortality rate) together with high sensitivity and specificity prediction of stricture/stenosis formation 21 days post-ingestion (95.65%-70%, 91.49%-55.56%, 95.35%-45.5%, 92.86%-42.86% respectively). Lower pH and Hb levels were more evident in the complicated group and were correlated with poor outcome. While, higher WBCs were only correlated with longer hospital stay time. Acidosis and anemia had significant sensitivity (91.30%-90.91% respectively) and specificity (44.43%-41.67% respectively) prediction of stricture/stenosis formation.Conclusion: In children corrosive ingestion, some clinical manifestations as vomiting, drooling, dysphagia and hematemesis together with laboratory data as decreased pH and Hb levels and increased WBCs count on admission, were more obvious in the complicated cases and were found to be reliable predictors of outcome severity. Recommendations: It is recommended to carefully monitor initial signs and symptoms together with laboratory data to predict the outcome severity and avoid complications early enough.

Calcium channel blockers (CCB) drugs poisoning continues to be deadly in severe cases despite recent advances and aggressive therapies. Clinically, this toxicity can manifest into severe cardiogenic shock that is often unresponsive to conventional calcium and supportive treatment. This study aimed to investigate the effectiveness of L-carnitine, as an essential compound in cellular energy production, and intralipid emulsion 20% (ILE), as an adjunctive antidote used in selected critically ill poisoned patients, for the treatment of hypotension, Electrocardiogram (ECG) changes and arterial blood gases (ABG) deficits in verapamil poisoned rats, either separately or in combination. The study was conducted on 64 albino rats divided into 8 groups (each of 8 rats). The groups are: group 1 (negative control group), group 2 (Lcarnitine group), group 3 (ILE group), group4 (L-carnitine and ILE group), group 5 (verapamil group), group 6 (verapamil and L-carnitine group), group7 (verapamil and ILE group), group8 (verapamil, Lcarnitine and ILE group). All animals were subjected to measurement of blood pressure, ECG recording, as well as ABG. Results: verapamil toxicity in group 5 was manifested by significant hypotension (both systolic and diastolic), ECG derangements in the form of bradycardia, prolongation of PR and QT intervals and ABG changes in the form of significant low (pH, HCO3, PaO2 and PaCO2). L-carnitine and ILE separate administration with verapamil in group 6 and group 7 respectively improved the blood pressure, heart rate, ECG and ABG parameters but they still showed statistical significant difference with both the control group and group 8, regarding)blood pressure and ECG(in group 6 and)blood pressure, ECG and ABG(in group 7. Co-administration of L-carnitine and ILE together with verapamil in group 8 showed significant improvement of all toxic parameters with insignificant difference with the control group. In conclusion, this study proved that the combined use of L-carnitine and ILE was the most effective treatment of verapamil-induced acute cardiotoxicity. Further studies are recommended on larger scale and on clinical implication to establish more the advantageous and disadvantageous of this novel therapy. It is recommended to use this novel therapy as an additive to the usual regime and when the latter fails to correct potentially fatal cases of CCB poisonings.

Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have recently gained popularity as simple, inexpensive, and highly accurate inflammatory markers and they have been suggested as useful predictors for clinical prognosis in critically ill patients in various medical conditions. This study aimed to assess the usefulness of NLR and PLR in predicting the severity of clinical profile and outcome in patients with snake poisoning. Methods: a prospective study