.: ORİJİNAL ARAŞTIRMA
Akrep Sokması Vakalarında Prognozu Öngören Belirteçler: Üçüncü Basamak Çocuk Acil Servis Kesitsel Çalışması
Predictors of Prognosis in Scorpion Sting Cases: Cross-sectional Study of the Third Care Pediatric Emergency Service
Turkiye Klinikleri J Pediatr. 2021;30(3):177-83
doi: 10.5336/pediatr.2021-82083
Makale Dili: TR
Tam Metin
Ücretsiz Erişim
ÖZET
Amaç: Çalışmamızda, akrep sokması nedeniyle başvuran çocukların klinik bulgularını ve laboratuvar sonuçlarını değerlendirmek, hastaların tedaviye yanıtlarını, prognozlarını belirlemek ve ileri evre vakaları öngörmede kullanılacak belirteçleri saptamak amaçlandı. Gereç ve Yöntemler: Ocak 2008 ve Kasım 2020 tarihleri arasında Sağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma Hastanesi çocuk acil servisine akrep sokması nedeniyle başvuran hastaların epidemiyolojik, klinik, laboratuvar özellikleriyle tedavi ve prognozları geriye dönük olarak dosya verilerinden incelendi. Bulgular: Akrep sokması nedeniyle acil servisimize başvuran toplam 77 hastanın ortalama yaşı 82,3±57,3 ay idi. Başvuran hastaların 60'ının (%77,9) klinik derecelendirmesi Evre I, 12'si (%15,6) Evre II, 4'ü (%5,2) Evre III ve 1'i (%1,3) Evre IV olarak saptandı. Evrelemeye göre karşılaştırma yapıldığında Evre I hastaların kreatinin kinaz [creatinine kinase (CK)] ortalaması 175,7±78,8 U/L, nötrofil sayı ortalaması 5,9±3,3 x103/uL, serum amilaz değer ortalaması 69,3±42,2 U/L olup; Evre II-III-IV hastaların ise CK ortalaması 360±309,3 U/L, nötrofil sayı ortalaması 9,9±4,6 x103/uL, serum amilaz ortalaması 113,6±81,2 U/L olarak saptandı (p<0,05). Laboratuvar değerleri yatan-ayaktan taburcu ve antivenom verilen-verilmeyen hastalarda da karşılaştırıldı ve aynı parametreler anlamlı yüksek bulundu (p<0,05). Sonuç: Akrep sokması vakalarında hastaların klinik olarak kötüye gidebileceği her zaman akılda tutulmalıdır. Serum CK, nötrofil sayısı ve amilaz değerleri hastalarda klinik prognozu belirlemede etkili olabilir.
Anahtar Kelimeler: Acil servis; akrep sokması; çocuk
Amaç: Çalışmamızda, akrep sokması nedeniyle başvuran çocukların klinik bulgularını ve laboratuvar sonuçlarını değerlendirmek, hastaların tedaviye yanıtlarını, prognozlarını belirlemek ve ileri evre vakaları öngörmede kullanılacak belirteçleri saptamak amaçlandı. Gereç ve Yöntemler: Ocak 2008 ve Kasım 2020 tarihleri arasında Sağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma Hastanesi çocuk acil servisine akrep sokması nedeniyle başvuran hastaların epidemiyolojik, klinik, laboratuvar özellikleriyle tedavi ve prognozları geriye dönük olarak dosya verilerinden incelendi. Bulgular: Akrep sokması nedeniyle acil servisimize başvuran toplam 77 hastanın ortalama yaşı 82,3±57,3 ay idi. Başvuran hastaların 60'ının (%77,9) klinik derecelendirmesi Evre I, 12'si (%15,6) Evre II, 4'ü (%5,2) Evre III ve 1'i (%1,3) Evre IV olarak saptandı. Evrelemeye göre karşılaştırma yapıldığında Evre I hastaların kreatinin kinaz [creatinine kinase (CK)] ortalaması 175,7±78,8 U/L, nötrofil sayı ortalaması 5,9±3,3 x103/uL, serum amilaz değer ortalaması 69,3±42,2 U/L olup; Evre II-III-IV hastaların ise CK ortalaması 360±309,3 U/L, nötrofil sayı ortalaması 9,9±4,6 x103/uL, serum amilaz ortalaması 113,6±81,2 U/L olarak saptandı (p<0,05). Laboratuvar değerleri yatan-ayaktan taburcu ve antivenom verilen-verilmeyen hastalarda da karşılaştırıldı ve aynı parametreler anlamlı yüksek bulundu (p<0,05). Sonuç: Akrep sokması vakalarında hastaların klinik olarak kötüye gidebileceği her zaman akılda tutulmalıdır. Serum CK, nötrofil sayısı ve amilaz değerleri hastalarda klinik prognozu belirlemede etkili olabilir.
Anahtar Kelimeler: Acil servis; akrep sokması; çocuk
ABSTRACT
Objective: It was aimed to determine the clinical appearance, laboratory results, treatment, and prognosis of children presenting with scorpion sting and aims to determine the predictive markers in cases of advanced stages. Material and Methods: The patients who were admitted to the Pediatric Emergency Clinic of Health Sciences University Tepecik Education and Research Hospital between January 2008 and November 2020 with a complaint of scorpion sting were analyzed retrospectively in terms of epidemiological features, clinical appearance, laboratory results, treatment methods, and prognosis. Results: The mean age of 77 patients who were admitted to our emergency department due to scorpion stings was 82.3±57.3 months. The clinical grade of 60 patients (77.9%) who were admitted was Stage I, 12 (15.6%) of them was Stage II, 4 (5.2%) was Stage III, and one (1.3%) was detected as Stage IV. When compared according to staging, the mean creatinine kinase (CK) of patients with stage I was 175.7±78.8 U/L, mean neutrophil count was 5.9±3.3 x103/uL, mean serum amylase value is 69.3'±42.2 U/L; in patients with Stage II-IIIIV, mean CK level was 360±309.3 U/L, mean neutrophil count was 9.9±4.6 x103/uL, mean serum amylase level was 113.6±81.2 U/L (p<0.05). When laboratory values were compared between inpatientoutpatient discharge and antivenom given and not given patients, the same parameters were found to be significantly higher (p<0.05). Conclusion: It should always be kept in mind that patients with scorpion sting may deteriorate clinically. Serum CK levels, neutrophil count, and amylase levels may be used effectively in determining clinical prognosis in patients with scorpion sting.
Keywords: Emergency service; scorpion sting; child
Objective: It was aimed to determine the clinical appearance, laboratory results, treatment, and prognosis of children presenting with scorpion sting and aims to determine the predictive markers in cases of advanced stages. Material and Methods: The patients who were admitted to the Pediatric Emergency Clinic of Health Sciences University Tepecik Education and Research Hospital between January 2008 and November 2020 with a complaint of scorpion sting were analyzed retrospectively in terms of epidemiological features, clinical appearance, laboratory results, treatment methods, and prognosis. Results: The mean age of 77 patients who were admitted to our emergency department due to scorpion stings was 82.3±57.3 months. The clinical grade of 60 patients (77.9%) who were admitted was Stage I, 12 (15.6%) of them was Stage II, 4 (5.2%) was Stage III, and one (1.3%) was detected as Stage IV. When compared according to staging, the mean creatinine kinase (CK) of patients with stage I was 175.7±78.8 U/L, mean neutrophil count was 5.9±3.3 x103/uL, mean serum amylase value is 69.3'±42.2 U/L; in patients with Stage II-IIIIV, mean CK level was 360±309.3 U/L, mean neutrophil count was 9.9±4.6 x103/uL, mean serum amylase level was 113.6±81.2 U/L (p<0.05). When laboratory values were compared between inpatientoutpatient discharge and antivenom given and not given patients, the same parameters were found to be significantly higher (p<0.05). Conclusion: It should always be kept in mind that patients with scorpion sting may deteriorate clinically. Serum CK levels, neutrophil count, and amylase levels may be used effectively in determining clinical prognosis in patients with scorpion sting.
Keywords: Emergency service; scorpion sting; child
REFERANSLAR:
- Isbister GK, Bawaskar HS. Scorpion envenomation. N Engl J Med. 2014;371(5):457-63. [Crossref] [PubMed]
- Cupo P. Clinical update on scorpion envenoming. Rev Soc Bras Med Trop. 2015;48(6):642-9. [Crossref] [PubMed]
- Chakroun-Walha O, Karray R, Jerbi M, Nasri A, Issaoui F, Amine BR, et al. Update on the Epidemiology of scorpion envenomation in the south of Tunisia. Wilderness Environ Med. 2018;29(1):29-35. [Crossref] [PubMed]
- Uluğ M, Yaman Y, Yapici F, Can-Uluğ N. Scorpion envenomation in children: an analysis of 99 cases. Turk J Pediatr. 2012;54(2):119-27. [PubMed]
- Bosnak M, Ece A, Yolbas I, Bosnak V, Kaplan M, Gurkan F. Scorpion sting envenomation in children in southeast Turkey. Wilderness Environ Med. 2009;20(2):118-24. [Crossref] [PubMed]
- Yılmaz F, Arslan ED, Demir A, Kavalci C, Durdu T, Yılmaz MS, et al. Epidemiologic and clinical characteristics and outcomes of scorpion sting in the southeastern region of Turkey. Ulus Travma Acil Cerrahi Derg. 2013;19(5):417-22. [Crossref] [PubMed]
- Özkan Ö, Karaer KZ. Türkiye akrepleri [The scorpions in Turkey]. Türk Hij Den Biyol Derg. 2003;60(2):55-62. [Link]
- Chippaux JP, Goyffon M. Epidemiology of scorpionism: a global appraisal. Acta Trop. 2008;107(2):71-9. [Crossref] [PubMed]
- Abourazzak S, Achour S, El Argam L, Atmani S, Chaouki S, Semlali L, et al. Epidemiological and clinical characteristics of scorpion stings in children in fez, Morocco. J Venom Anim Toxins incl Trop Dis. 2009;15(2):255-67. [Crossref]
- Al-Sadoon MK, Jarrar BM. Epidemiological study of scorpion stings in Saudi Arabia between 1993 and 1997. J Venom Anim Toxins incl Trop Dis. 2003;9(1):54-64. [Crossref]
- Pardal PP, Castro LC, Jennings E, Pardal JS, Monteiro MR. Aspectos epidemiológicos e clínicos do escorpionismo na região de Santarém, Estado do Pará, Brasil. citbelem@yahoo.com [Epidemiological and clinical aspects of scorpion envenomation in the region of Santarém, Pará, Brazil]. Rev Soc Bras Med Trop. 2003;36(3):349-53. [Crossref] [PubMed]
- Al-Asmari AK, Al-Saif AA. Scorpion sting syndrome in a general hospital in Saudi Arabia. Saudi Med J. 2004;25(1):64-70. [PubMed]
- Forrester MB, Stanley SK. Epidemiology of scorpion envenomations in Texas. Vet Hum Toxicol. 2004;46(4):219-21. [PubMed]
- Bayar Taş C. Mesobuthus gibbosus (buthidae) akrep venomunun saflaştırılması ve bazı fizyolojik etkilerinin belirlenmesi [Doktora Tezi]. Ankara: Hacettepe Üniversitesi; 2004. [Link] Tez no: 155303
- Bouaziz M, Bahloul M, Kallel H, Samet M, Ksibi H, Dammak H, et al. Epidemiological, clinical characteristics and outcome of severe scorpion envenomation in South Tunisia: multivariate analysis of 951 cases. Toxicon. 2008;52(8):918-26. [Crossref] [PubMed]
- Elzey BD, Tian J, Jensen RJ, Swanson AK, Lees JR, Lentz SR, et al. Platelet-mediated modulation of adaptive immunity. A communication link between innate and adaptive immune compartments. Immunity. 2003;19(1):9-19. [Crossref] [PubMed]
- Pascual-González Y, López-Sánchez M, Dorca J, Santos S. Defining the role of neutrophil-to-lymphocyte ratio in COPD: a systematic literature review. Int J Chron Obstruct Pulmon Dis. 2018;13:3651-2. [Crossref] [PubMed] [PMC]
- Cedrés S, Torrejon D, Martínez A, Martinez P, Navarro A, Zamora E, et al. Neutrophil to lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non-small cell lung cancer. Clin Transl Oncol. 2012;14(11):864-9. [Crossref] [PubMed]
- Yu Y, Qian L, Cui J. Value of neutrophil-to-lymphocyte ratio for predicting lung cancer prognosis: A meta-analysis of 7,219 patients. Mol Clin Oncol. 2017;7(3):498-506. [Crossref] [PubMed] [PMC]
- Borges A, Trejo E, Vargas AM, Céspedes G, Hernández A, Alfonzo MJ. Pancreatic toxicity in mice elicited by Tityus zulianus and Tityus discrepans scorpion venoms. Invest Clin. 2004;45(3):269-76. [PubMed]
- Tobler I, Stalder J. Rest in the scorpion-a sleep-like state? J Comp Physiol A. 1988;163:227-35. [Crossref]
- Chippaux JP. Rôle de l'environnement sur l'incidence et la sévérité des envenimations [Impact of the environment on envenomation incidence and severity]. Med Sci (Paris). 2009;25(10):858-62. [Crossref] [PubMed]
- Monteiro WM, de Oliveira SS, Pivoto G, Alves EC, de Almeida Gonçalves Sachett J, Alexandre CN, et al. Scorpion envenoming caused by Tityus cf. silvestris evolving with severe muscle spasms in the Brazilian Amazon. Toxicon. 2016;119:266-9. [Crossref] [PubMed]
- Chippaux JP. Emerging options for the management of scorpion stings. Drug Des Devel Ther. 2012;6:165-73. [Crossref] [PubMed] [PMC]
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