Text Box: BIOCHEMICAL ASSESSMENT OF MYOCARDIAL INJURY IN SCORPION ENVENOMED CHILDREN
MOHIE-ELDEEN, Z.M.* AND MEKKI, A.A. 
*PEDIATRIC DEPT., ASSIUT UNIVERSITY HOSPITAL, EGYPT

Objectives: To investigate the value of different biochemical markers and cytokines for early diagnosis and prognosis of myocardial injury in cases of scorpion envenomation in children. 
Method: 41 victims of scorpion envenomation aged 1.5 C 12 years ( /  26/15) in addition to 15 normal healthy controls were studied. The patients were classified to three groups: group A : 17 patients with clinical signs of myocarditis, group B: 14 children with moderate manifestations of envenomation including heart failure without clinical myocarditis, group C: 10 patients with only local pain at the site of scorpion sting. Serum levels of lactate dehydrogenase (LDH), creatine phosphokinase (CPK), creatine phosphokinase isoenzyme (CPK-MB), cardiac treponin I (cTI) and interleukin-8 (IL8) were estimated once for the control group and twice for the patient, firstly on admission and follow up after 48 hours.  Serum levels of LDH, CPK, CPK-MB were detected by spectrophotometer, cTI was estimated using chemilumiescent enzyme immunometric assay. The level of IL8 was estimated using ELISA method.   
Results:  Group A patients showed significant higher mean values of CPK, CPK-MB, cTI and IL8 in comparison to groups B and C both on admission and on follow up. The patients with toxic myocarditis and shock showed significant higher mean values of cTI initially and on follow up in comparison to those with myocarditis without shock (P<0.005 for each). In group A patients, the non survivors showed significant higher mean value of cTI on admission than in the survivors (P<0.025). The cut off level of cTI for diagnosis of myocarditis in scorpion envenomed children in this study was found to be >1 ng/ml. The specificity and sensitivity of cTI for diagnosis of myocarditis in cases of scorpion envenomation were 100%. Significant +ve correlation was found between IL8 and cTI only in patients of group A (R=0.28, P<0.05). 
Conclusion: The high specificity and sensitivity of cTI suggests its potential use in the early assessment of cases of scorpion envenomation for diagnosis of myocarditis. A level of cTI of >1ng/ml is suggested for diagnosis of myocarditis in envenomed children. The significant elevation of cTI in shocked and non-survivor patients could be an indicator for a poor outcome. 




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