Leptin gene polymorphism affects leptin level in childhood asthma

Background

Leptin may induce inflammation in asthma by activation of Th2 cells. It has also been demonstrated that leptin expression increases upon inflammation and that asthmatic patients show increased serum leptin levels. We hypothesized that the polymorphism in leptin (LEP) and leptin receptor (LEPR) genes is associated with childhood asthma and may affect their serum level. To our knowledge, there are no reports analyzing LEP and LEPR polymorphisms in association with their serum levels in childhood asthma.

Methods

We analyzed 35 subjects: 25 asthmatic pediatric patients and 10 healthy children aged from 6 to 18. The diagnosis of allergic asthma was based on clinical manifestation, lung function, positive skin prick tests and increased immunoglobulin E levels. The polymorphisms were genotyped with use of polymerase chain reaction-restriction fragment length polymorphism method. Serum levels of leptin and leptin receptor were determined using BioVendor enzyme-linked immunosorbent assay kits. Statistical analysis was done with Statistica v.12.

Results

We observed that leptin levels were increased in asthmatic subjects as compared to healthy controls and were significantly higher during exacerbation than in the asymptomatic period (P?=?0.025). We observed that LEP polymorphism (rs13228377) was associated with higher serum leptin levels in asthma and these two variables had high predictive value for asthma risk (P?=?0.007, odds ratio 17.5, predictive accuracy 83.9%). LEPR polymorphisms did not show association with its serum level and asthma risk.

Conclusion

LEP polymorphism may increase asthma risk via influence on its serum level.

     

The effect of the broad-spectrum antibiotics for prevention of postoperative intra-abdominal abscess in pediatric acute appendicitis

Background

We investigated the efficacy of broad-spectrum antibiotics for prevention of postoperative intra-abdominal abscess in pediatric acute appendicitis with our 3 risk factors:—WBC?>?16.5 (×?10³/µl), CRP?>?3.1 (mg/dl) and appendix maximum short diameter on diagnostic imaging?>?11.4 mm.

Methods

Four hundred twenty-two patients were reviewed. Patients with 0–1 risk factors were assessed as low-risk and those with 2–3 were high-risk. In the low-risk group, Group A (n?=?66) patients received broad-spectrum antibiotics and Group B patients (n?=?265) received narrow-spectrum monotherapy. In the high-risk group, Group C patients (n?=?63) received broad-spectrum antibiotics and Group D patients (n?=?28), narrow-spectrum antibiotics. The outcomes were the incidence of postoperative abscess and the total duration of intravenous (IV) antibiotics.

Results

The incidence of intra-abdominal abscess was 6.06% in Group A versus 1.89% in Group B (p?=?0.08), and 19.05% in Group C versus 3.57% in Group D (p?=?0.06). Total IV antibiotic duration (days) were 6.12?±?2.87 in Group A versus 3.83?±?0.69 in Group B (p?<?0.01), and 7.84?±?4.57 in Group C versus 4.00?±?0.82 in Group D (p?<?0.01).

Conclusion

Broad-spectrum antibiotics did not prevent postoperative intra-abdominal abscess in either low or high-risk groups.

     

Impact of the Bowel Management Program on the quality of life in children with fecal incontinence

Purpose

Evaluate the impact of implementing Bowel Management Program (BMP) on quality of life (QoL) in children with fecal incontinence (FI).

Methods

Children 3–12 years referred to the Children’s Treatment Center of FI were included and categorized accordingto the tendency to constipation (dilated colon; group 1) or diarrhea (non-dilated colon; group 2). Evaluations were performed before and after 3 months of BMP implementation. Perceptions from parents and children about QoL were assessed by the instrument PedsQL4.0 and the severity of FI by the fecal incontinence index (FII) of Wexner scale.

Results

43 children (mean age of 7.7 ± 3.1) were studied. 32 (74.4 %) belonged to group 1 and 11 (25.6 %) to group 2. After 3 months of BMP, it was noticed a significant improvement of the FII (14.5 ± 3.7 versus 2.8 ± 2.5; p < 0.001) in both groups. QoL perception by the parents and children increased on PedsQL4.0 evaluation (p < 0.001). There was a medium inverse statistically significant correlation of the FII and the total PedsQL4.0 score among children and parents (r = ?0.47, p = 0.009 and r = ?0, 39, p = 0.03, respectively).

Conclusion

The BMP applied by a multidisciplinary dedicated team significantly improves the QoL of children with FI in the short-term period.

     

Quality of Life (QoL) and the Factors Affecting it in Transfusion-dependent Thalassemic Children

Objectives

To evaluate the Quality of life (QoL) and the factors affecting it in transfusion-dependent thalassemic children.

Methods

Current study was conducted at Department of Pediatrics, Dr. SNMC, Jodhpur. Ninety-three transfusion-dependent thalassemic children aged between 8 and 18 y were enrolled. Quality of life was assessed using Pediatric Quality of Life (PedsQL) measurement model in thalassemic children.

Results

Mean age of children was 11.8?±?3.2 y. Lowest mean score was observed in School functioning (57.4) while in Physical functioning, Emotional functioning and Social functioning it was 73.9, 82.2 and 83.49 respectively. Mean PedsQL score was higher in 8-12 y age group as compared to 13-18 y (p?=?0.024). PedsQL score was higher in children who required transfusion once in a month (p?=?0.028) and children on combined chelation therapy as compared to children who were on injectable chelator (p?=?0.039). Health Related QoL was not affected with gender, education status, family history of thalassemia, ferritin level, splenectomy or consanguinity.

Conclusions

Factors related with low QoL in current study were higher age, increased transfusion frequency and injectable mode of chelation. In order to improve the QoL in thalassemic children appropriate programmes and interventions should be started targeting above domains.

     

Relationship between immune parameters and non-alcoholic fatty liver disease in obese children

Objective

To investigate the relationship between immune parameters and non-alcoholic fatty liver disease (NAFLD) in obese children.

Design

Cross-sectional study

Setting

Hospital-based study in Zhejiang Province, China between July to September 2015.

Participants

A total of 117 obese children and 209 healthy nonobese children were studied as the obese and control groups. Depending on the severity of NAFLD, the obese group was divided into subgroups 1 (without NAFLD), 2 (with simple fatty liver) and 3 (with steatohepatitis).

Outcome Measures

Glucose metabolism, lipid metabolism and immune parameters.

Results

In the obese group, body mass index (BMI), waist-and hip-circumferences, fasting insulin, Homeostasis model of assessment for insulin resistance (HOMA-IR), triglyceride, total cholesterol, low density lipoprotein cholesterol (LDL-C), apolipoprotein (Apo)B/ApoA1, alanine aminotransferase, uric acid, white blood cells, neutrophils percentage, platelet and interleukin (IL)-6 were significantly higher than those in the controls (P<0.05), while lower high density lipoprotein cholesterol and lymphocyte percentage were noted (P<0.05). IL-10 in the subgroup 3 was higher than those in the control group, subgroup 1 and 2 (P<0.05). Logistic regression analysis showed that BMI, LDL-C, HOMA-IR and IL-10 were independent factors of NAFLD (P<0.05).

Conclusions

These results support a low-grade chronic inflammation in obese children. Moreover, obesity, dyslipidaemia and IR are risk factors while IL-10 may be a protective factor for NAFLD.

     

Relation of thyroid hormone levels with fluid-resistant shock among preterm septicemic neonates

Objective

To compare thyroid hormone levels between septicemic preterm neonates with and without shock.

Methods

Preterm septicemic infants with shock constituted Group A (n=36) and those without shock constituted Group B, with groups matched (1:1) for gestation and postnatal age. Those with maternal thyroid disorders, thyrotropic medication and life expectancy <12 hours were excluded. We compared serum tri-iodothyronine (T3), thyroxine (T4) and thyroid-stimulating hormone (TSH) between the groups by univariate and multivariate (adjusting for SNAPPE-II) analysis.

Results

Median (IQR) TSH was significantly lower in Group A [1.39 (0.83,3.48)] vs Group B [5.1 (2.32,7.19)] mmol/dL (P<0.001). Serum T3 and T4 were also lower in Group A (P<0.001). On multivariate analysis, none of these measures were independently associated with septic shock.

Conclusions

Thyroid hormone levels do not independently predict presence of shock among septic preterms.

     

Effect of conventional and LED phototherapy on the antioxidant-oxidant status in preterm neonates with jaundice

Objective

To compare oxidative stress due to conventional and LED phototherapy among jaundiced preterm neonates.

Methods

Cross-sectional study conducted in NICU on 82 neonates (equal numbers received conventional and LED phototherapy). Total antioxidant capacity (TAC), total oxidant status (TOS) and Oxidative stress index (OSI) were assessed.

Results

Post-phototherapy, mean (SD) OSI increased significantly compared to baseline in both conventional [0.26 (0.24) vs. 0.61 (0.41); P <0.001] and LED groups [0.24 (0.20) vs. 0.32 (0.23); P <0.001]. Across groups, mean (SD) TAC was lower [0.28 (0.16) vs. 0.53 (0.27); P <0.001] mmol Trolox equiv/L; mean (SD) TOS higher [15.6 (10.9) vs. 14.6 (10.2); P=0.711] μmol H₂O₂/L and mean (SD) OSI higher [0.61 (0.42) vs. 0.33 (0.23); P <0.001] in conventional as compared to LED phototherapy.

Conclusion

Both modes increased oxidative stress index; however, conventional phototherapy resulted in higher oxidative stress.

     

Risk Factors for Microbiologically-documented Infections,Mortality and Prolonged Hospital Stay in Children with Febrile Neutropenia

Objective

To analyze the risk factors for microbiologically documented infection, mortality and hospital stay more than 5 days in children with febrile neutropenia.

Design

Cross-sectional study (July 2013-September 2014).

Setting

Government-run, tertiary-care, university hospital in Chandigarh, Northern India.

Participants

414 episodes in 264 children aged <12 years, not undergoing stem-cell transplantation.

Outcome measures

Predictors for ‘high-risk’ febrile neutropenia.

Results

Microbiologically-documented infections were observed in 82 children (19.8%); bacterial 14.2%, fungal 4.3%, polymicrobial 9.7%. Complications were documented in 109 (26%) children. 43 (10.3%) died: 8 due to fungal and 35 due to bacterial sepsis. Children admitted within 7 days of the last chemotherapy (P<0.01) and having a non-upper respiratory focus of infection (P<0.02) were at risk of developing microbiologicallydocumented infections and death. Platelet count <20000/uL (P=0.03) was an additional predictor for microbiologicallydocumented infections, while albumin <2.5 g/dL (P=0.04) and Creactive protein >90 mg/L (P=0.02) were risk factors predicting mortality. The median (IQR) duration of hospital stay was 5 (3,8) days. Hospital stay <5 days was seen in 144 (35%) children. Children with acute myeloid leukaemia (P<0.01) and admitted within 7 days of chemotherapy (P=0.02) were likely to have a prolonged hospital stay >5 days.

Conclusions

Febrile neutropenic children admitted within 7 days of completion of chemotherapy, those with a non-upper respiratory focus of infection, CRP >90 mg/dL, platelet <20000/uL and albumin <2.5 g/dL need to be considered as ‘high risk’ for complications and mortality.

     

Comparison of transcutaneous bilirubin measurement with total serum bilirubin levels in preterm neonates receiving phototherapy

Objective

To compare transcutaneous bilirubin with total serum bilirubin in preterm neonates after initiation of phototherapy.

Methods

Jaundice was assessed in 30 preterm neonates with transcutaneous bilirubin and total serum bilirubin before initiation of phototherapy and at 12 hr after initiation of phototherapy. A photo-occlusive patch was applied over the sternum.

Results

Transcutaneous bilirubin has a good correlation with total serum bilirubin after initiation of phototherapy. (r=0.918, P<0.001). Transcutaneous bilirubin at 28-32 weeks of gestation (r = 0.97) was better correlated with total serum bilirubin than those at 32-37 weeks (r =0.88). The correlation was better for neonates <72 hours old (r = 0.96) than those >72 hours of age (r = 0.82).

Conclusion

Transcutaneous bilirubin correlates significantly with total serum bilirubin at the patched sternal site after initiation of phototherapy in preterm neonates.

     

The factors associated with successful early enteral feeding in gastroschisis

Background

Gastroschisis is the most common congenital abdominal wall defect. Due to the exposure of midgut to amniotic fluid, the recovery of bowel function is often delayed. This study aimed to identify the factors associated with the successful early enteral feeding in gastroschisis and to develop further guidelines of treatment.

Methods

A retrospective cohort study of gastroschisis babies from January 2006 to December 2015 was done. Exclusion criteria were incomplete data and death. Successful early enteral feeding was defined when full feeding was achieved within 21 days of life.

Results

One hundred and five gastroschisis patients were divided into a successful early-feeding group (n?=?56, 53%) and a non-successful early-feeding group (n?=?49, 46%). In multivariable analysis, significant factors for successful feeding clustered by primary treatment were female (RR?=?1.38, P value <?0.001), gestational age >?36 weeks (RR?=?1.23, P value <?0.001), age at surgery less than 10 h (RR?=?1.15, P value <?0.001), postoperative extubation time <?4 days (RR?=?1.39, P value <?0.001), and age when feeding started less than 10 days (RR?=?35.69, P value?<?0.001).

Conclusion

Several factors were found to be associated with successful early enteral feeding. The modifiable factors found in this study were surgery within 10 h, early postoperative extubation within 4 days, and feeding started before 10 days of life. These will guide the management of gastroschisis to achieve successful early enteral feeding.

     

Laparoscopic <Emphasis Type="Italic">versus</Emphasis> open appendectomy for acute appendicitis in children

Objective

To compare the efficacy and safety of laparoscopic appendectomy and open appendectomy for acute appendicitis in children.

Methods

This study was conducted as a retrospective comparison of hospital records for postoperative complications, duration of operation, and postoperative length of stay between children (aged <18y) who underwent laparoscopic (n=190) or open (n=199) appendectomy over a six-year period. Quality of life was evaluated immediately and 1 month postoperatively.

Results

The major complication rate after surgery in laparoscopic group was significantly lower than that of open appendectomy group (13% vs 27%, P<0.05). The mean (SD) postoperative hospital stay was also shorter in laparoscopic group (2.4 (0.6) days vs 3.7 (1.1) days, P<0.05). The postoperative minor complication rate and hospital expenses were not significantly different between the two groups. The duration of surgery was longer in laparoscopic group (P<0.05). Children in laparoscopic group had less postoperative pain and higher quality of life after one month than those in open appendectomy group.

Conclusions

Laparoscopic technique seems to be safer than open appendectomy for acute appendicitis in children.

     

Growth failure in hereditary spherocytosis and the effect of splenectomy

Objectives

To analyze growth-failure and improvement, if any, following splenectomy in children with hereditary spherocytosis.

Methods

Data collection from case-records (n=82) over 27-years (1985-2011).

Results

Prevalence of stunting was 26%; 32% were underweight. Stunted children were older in age (P=0.006) and presented late (P=0.003). Splenectomy (n=26) improved anemia (P<0.001). However, height-for-age did not improve at 1-year, or 4.5-years (median) following splenectomy (P=1.0). Number of underweight children did not reduce at 1-(P=0.21), or 4.5-years (P=0.21) following surgery.

Conclusion

Growth-failure is frequent in children with hereditary spherocytosis in India. Splenectomy corrected the anemia but failed to improve the growth.

     

Profile of bullies and victims among urban school-going adolescents in Gujarat

Objective

To assess the prevalence of bullying, identifying bullies, victims and their associations.

Methods

Questionnaire having ‘Peer Interaction in Primary Schools’ and ‘Strength and Difficulty Questionnaire’ scales, and demographic information was administered to 7th, 8th and 9th graders (N=1106).

Results

Prevalence of bullying was 49%. Boys were more likely to be bullies (P=0.03), whereas students having less friends (P=0.001), overweight/obese (P=0.02), and boys (P<0.001) were more likely to be victims. Association between bullying behavior and poor academic performance was noted.

Conclusions

We found high prevalence of bullying. The reasons for the same and scope of intervention needs further study.

     

Evaluation of serum 25-Hydroxy vitamin D levels in children with autism Spectrum disorder

Background

Vitamin D plays an important role in etiology of Autism Spectrum Disorders (ASDs). We aimed to evaluate the serum 25 - hydroxyl vitamin D level among children with ASDs in Ahvaz city, Iran.

Methods

It was a cross-sectional study which had conducted on 62 subjects in two groups: a case group (n?=?31) consisted of ASD children who study in especial schools; and a control group (n?=?31) of healthy children who were selected by simple random sampling from regular schools in Ahvaz city, Iran during 2016. Maching between two groups has done regarding Socioeconomic status, type and amount of food intake, place of living and age. The levels of serum 25 - hydroxyl vitamin D were assessed in early morning means fasted state and also measured using ELISA method. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. The significant level was considered < 0.05.

Results

In ASD children, the average serum 25-hydroxyvitamine D level was 9.03?±?4.14?ng/mg. In ASD group, 96.8% (30 subjects) had vitamin D deficiency. In healthy children group, average serum 25-hydroxyvitamine D level was 15.25?±?7.89?ng/mg. Average serum 25-hydroxyvitamine D level in intervention group was significantly lower than the control group (P?>?0.001). Although the parents of patients in control group reported longer exposure to sun (27.42?m per day against 33.06?m per day), no significant difference was observed between these groups in terms of exposure to sun (P?< 0.05).

Conclusions

A significant difference was observed between serum 25-hydroxyvitamine D levels between the healthy and ASD children. It is recommended to use vitamin D supplement in children with ASDs under medical care.

     

Airway foreign bodies in pediatric patients: anatomic location of foreign body affects complications and outcomes

Background

Airway foreign bodies (FB) are a common medical emergency within the pediatric population. While deaths are not uncommon, the in-hospital mortality rates and correlation with anatomic location of the airway foreign body have not been previously reported.

Methods

The KID database was reviewed for 2003, 2006, 2009, and 2012 for pediatric patients with a discharge diagnosis of airway foreign body using ICD-9 codes (933.1, 934.x).

Results

11,793 patients, ages 0–17, were found to have an airway FB. Of patients admitted for airway FB 21.2 % required mechanical ventilation during their hospitalization, and the overall mortality rate was 2.5 %. Location of the airway FB was dependent on age (p < 0.01). Use of mechanical ventilation was dependent on the location of the airway FB (p < 0.01) and being transferred from another hospital (OR 2.59, p < 0.01). Univariate analysis demonstrated differences in in-hospital mortality based on location (p < 0.01), use of a ventilator during hospitalization (OR 24.4, p < 0.01), and transfer from another hospital (OR 2.11, p < 0.01).

Conclusions

The in-hospital mortality rate for airway foreign bodies is 2.5 %. The anatomic location of airway FB in pediatric patients varies by age, and affects the need for mechanical ventilation and in-hospital mortality.

     

Endothelial nitric oxide synthase gene polymorphisms are associated with sensitization to seasonal aeroallergens in asthmatic children

Background

Childhood asthma phenotype is the consequence of interaction between environment and genetic factors. Nitric oxide (NO) formation is affected by polymorphisms in nitric oxide synthase (NOS) enzymes, which play a significant role as inflammatory factors in the airways. This study was undertaken to estimate the correlation of -786C>T and 894G>T polymorphisms of the eNOS gene with the sensitization of asthmatic children to common aeroallergens.

Methods

A total of 193 asthmatic children and 96 healthy controls, who were of Mediterranean origin, living in the same geographical area, were enrolled in the study. 894G>T and -786T/C polymorphisms of the eNOS gene were analyzed using a PCR-RFLP method.

Results

The 894GG genotype was more frequent (68.6%) in children with asthma sensitized to Oleaeuropaea than in those with asthma non-sensitized (43.0%) (P=0.004). Likewise, -786TT genotype frequency was higher in children with asthma sensitized to Oleaeuropaea (51.0%) than in those with asthma nonsensitized (31.7%) to this allergen (P=0.035). For the aeroallergens Parietariajudaica and mixed grass, the frequency of -786C allele carriage was associated with protection from sensitization to Parietariajudaica and mixed grass in asthmatic children (P=0.021 and P=0.017, respectively). In the healthy control group, the genotype frequencies for these polymorphisms were similar to genotype frequencies of children with asthma non-sensitized to these three specific aeroallergens.

Conclusion

In children with asthma, 894G>T and -786T/C polymorphisms of the eNOS gene were correlated with sensitization to common seasonal aeroallergens.

     

Assessment of cardiac function in infants with transposition of the great arteries after surgery: comparison of two methods

Background

Assessment of cardiac function is crucial in pediatric patients undergoing cardiovascular surgery, monitoring cardiac output and changing hemodynamic conditions during surgery accordingly is important to improve post-surgical outcome. We aimed to measure cardiac index (CI) and maximal rate of the increase of left ventricular pressure dp/dt(max) with the pressure recording analytic method (PRAM, MostCare^®) and compared it with transthoracic echocardiographic cardiac index estimation in infants with transposition of the great arteries (TGA) undergoing surgical correction.

Methods

We enrolled 74 infants with TGA consecutively into this study. CI and dp/dt(max) were measured with PRAM and echocardiography at 0, 4, 8, 12, 24 and 48 h postoperatively. Blood brain natriuretic peptide (BNP) and blood lactate (Lac) were measured at baseline and after operation.

Results

The median age at surgery was 13 days (range 1–25 days) with an average weight of 3.24 kg (range 2.31–4.17 kg). CI estimated by PRAM was 1.11 ± 0.12 L/min/m² (range 0.69–1.36) and by Doppler echocardiography was 1.13 ± 0.13 L/min/m² (range 0.76–1.40). dp/dt(max) estimated by PRAM was 1.31 ± 0.03 mmHg/s (range 1.23–1.43) and by Doppler echocardiography was 1.31 ± 0.04 L/min/m² (range 1.25–1.47). CI (r = 0.817, P < 0.001) and dp/dt(max) (r?=?0.794, P?<?0.001) measured by two methods were highly correlated with a linear relation. Blood BNP and lactate increased to the highest level at 8–12 h post-operatively.

Conclusions

In the early post-operative period, PRAM provides reliable estimates of cardiac index and dp/dt(max) value compared with echocardiographic measurements. PRAM through mostcare^® is a reliable continuous monitoring method for peri-operative management in children with congenital heart disease.

     

Relationship between genotypes and clinical manifestation,pathology, and cccDNA in Chinese children with hepatitis B virus-associated glomerulonephritis

Background

Hepatitis B virus-associated glomerulonephritis (HBV-GN) is one of the extrahepatic manifestations after HBV infection, which would cause great clinical harm to people. The present study was undertaken to investigate the HBV-GN genotypes and its clinical relevance in Chinese children.

Methods

A total of 41 HBV-infected children diagnosed with HBV-GN were enrolled in the study. All patients underwent liver and kidney biopsy. The genotypes and cccDNA were detected in their serum samples to analyze the relationship between HBV genotypes and clinical characteristics, cccDNA, and pathology.

Results

Among the 41 children with HBV-GN, 29 (70.7%) had genotype C, 10 (24.4%) had genotype B, 2 (4.9%) had genotype B/C, and none of them had genotype non-B/C. Most children had genotypes B or C; moreover, the genotype C was the most frequent one. The incidence of hematuria and albuminuria, reduction in complement C3, increase in serum alanine aminotransferase levels and renal insufficiency in the children with genotype C were significantly higher than those in the children with genotype B (P<0.05); however, there was no statistically significant difference in hypertension and hepatomegaly (P>0.05). The frequency of HBV cccDNA positive in the genotype C group was significantly higher than that in the genotype B group (72.4% vs. 30.0%, P<0.05). No difference was observed in hepatic inflammation grades and stages of fibrosis between the two groups (P>0.05).

Conclusions

Genotype C was the most frequent genotype in the described group of patients with HBV-GN, and the liver and kidney damage indicators were more likely to occur in patients with genotype C.

     

Second Dose of Scorpion Antivenom in Children with Indian Red Scorpion (<Emphasis Type="Italic">Mesobuthus tamulus</Emphasis>) Sting Envenomation

Objective

To study the effect of the second dose of scorpion antivenom in children with nonresolving or worsening scorpion sting envenomation.

Methods

72 children aged ≤12 years with scorpion sting envenomation grade 2 and above were enrolled. 61 received the first dose of three vials of antivenom at admission (group A). Children with persistent/worsening envenomation within 6 hours received the second dose (group B). The time required for resolution of autonomic symptoms, myocardial dysfunction, predictors of the second dose and side effects were studied.

Results

The mean time taken for resolution of autonomic symptoms were comparable in Group A and B (4.1 vs. 5.3 h, P=0.4), and of myocardial dysfunction was shorter in Group A (10.8 vs. 37.6 h, P=0.02). On regression analysis, abnormal echocardiography at admission was found to be a significant predictor of the second dose (OR=27.6, 95% CI, 4.7–162.5; P=<0.001).

Conclusion

Children with severe scorpion sting envenomation with abnormal echocardiography may require a higher dose of scorpion antivenom.

Trial registration

CTRI/2015/03/005652.