Scorpion envenomation causes an autonomic storm resulting in changes in the vasoactive mediators’ levels which lead to myocardial damage, cardiovascular disturbances, peripheral circulatory failure, pulmonary edema, multi-system-organ-failure and death. The study aimed to determine the circulating levels of adrenaline, noradrenaline, angiotensin converting enzyme (ACE), Angiotensin II (Ang II), kallikrein enzyme, nitric oxide (NO), aldosterone, and electrolytes Naþ, Kþ and Caþ2 in scorpion envenomed children and to evaluate the potential relation between these vasoactive mediators, the severity of scorpion envenoming and the clinical outcome of envenomed children. Forty envenomed children (22 mild and 18 severe cases) along with 10 healthy control children were enrolled in the study. The circulating levels of adrenaline, noradrenaline, Ang II, ACE, kallikrein enzyme, and NO were determined by ELISA, and spectrophotometric assays on admission and 24 h later. On admission, serum aldosterone, and electrolytes; Naþ, Kþ and Caþ2 were determined by RIA, Flame photometer and Flame atomic absorption respectively. All envenomed children showed significant surge of adrenaline, noradrenaline, ACE, Ang II, aldosterone, NO and Naþ, that concomitantly faced by significant reduction in kallikrein, Kþ and Caþ2 on admission. Twenty four hours later, all envenomed children continued to show significant elevation of ACE, Ang II and NO. The severely envenomed children showed considerable reduction in circulating levels of adrenaline, noradrenaline, ACE and Ang II, while dramatic increase in kallikrein activity was reported in comparison to mildly envenomed children after 24 h of medical care. Also, NO exhibited considerable accumulation in non survivors, on admission, that was persistent for the subsequent 24 h and was accompanied by high kallikrein, low catecholamines and Ang II levels compared to survivors. Finally, the hypertensive cases showed substantial higher levels of catecholamine, ACE and Ang II, 24 h after admission. These findings indicated that, disturbances of the studied vasoactive mediators were common in scorpion envenomed children and may account for several inflammatory manifestations and clinical outcome. ACE inhibitors could be considered as possible therapeutic agent in victims with prominent increase in ACE and Ang II while kallikrein inhibitor and antioxidants may be effective in the treatment of late hypotensive ones.

Scorpion envenomation causes an autonomic storm resulting in changes in the vasoactive mediators’ levels which lead to myocardial damage, cardiovascular disturbances, peripheral circulatory failure, pulmonary edema, multi-system-organ-failure and death. The study aimed to determine the circulating levels of adrenaline, noradrenaline, angiotensin converting enzyme (ACE), Angiotensin II (Ang II), kallikrein enzyme, nitric oxide (NO), aldosterone, and electrolytes Naþ, Kþ and Caþ2 in scorpion envenomed children and to evaluate the potential relation between these vasoactive mediators, the severity of scorpion envenoming and the clinical outcome of envenomed children. Forty envenomed children (22 mild and 18 severe cases) along with 10 healthy control children were enrolled in the study. The circulating levels of adrenaline, noradrenaline, Ang II, ACE, kallikrein enzyme, and NO were determined by ELISA, and spectrophotometric assays on admission and 24 h later. On admission, serum aldosterone, and electrolytes; Naþ, Kþ and Caþ2 were determined by RIA, Flame photometer and Flame atomic absorption respectively. All envenomed children showed significant surge of adrenaline, noradrenaline, ACE, Ang II, aldosterone, NO and Naþ, that concomitantly faced by significant reduction in kallikrein, Kþ and Caþ2 on admission. Twenty four hours later, all envenomed children continued to show significant elevation of ACE, Ang II and NO. The severely envenomed children showed considerable reduction in circulating levels of adrenaline, noradrenaline, ACE and Ang II, while dramatic increase in kallikrein activity was reported in comparison to mildly envenomed children after 24 h of medical care. Also, NO exhibited considerable accumulation in non survivors, on admission, that was persistent for the subsequent 24 h and was accompanied by high kallikrein, low catecholamines and Ang II levels compared to survivors. Finally, the hypertensive cases showed substantial higher levels of catecholamine, ACE and Ang II, 24 h after admission. These findings indicated that, disturbances of the studied vasoactive mediators were common in scorpion envenomed children and may account for several inflammatory manifestations and clinical outcome. ACE inhibitors could be considered as possible therapeutic agent in victims with prominent increase in ACE and Ang II while kallikrein inhibitor and antioxidants may be effective in the treatment of late hypotensive ones.

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Purpose: The aim was to study High Resolution Anorectal Manometry (HRAM) in Egyptian population and the influence of age, gender and parity on manometric parameters. Methods: We studied 22 healthy volunteers 10 males and 12 females with median age 42 y (range: 18-61 y) by using solid state probe with 8 transducers 1 cm spaced with a rectal balloon mounted at the tip. The system is plotting graphs with high resolution topography and conventional pressure waves trac- ing as well (Solar GI MMS). Probe was introduced through the anal verge so the balloon is located at the rectum and the sensors at the rectum and analcanal. External EMG electrodes were applied on either sides of anus. Subjects were asked to relax, squeeze the anal sphincter, bear down, and cough to meas- ure anal pressures at these situations. Rectal sensation and recto-anal inhibi- tory reflex (RAIR) were evaluated by stepwise intermittent (10 ml) balloon distention. Finally balloon expulsion test was done. Results: Anal resting and maximum squeeze pressure were significantly higher in males than females (median; range: 61; 45-71 and 140.0; 67-224 vs. 42; 32-67 and 117; 58-220 respectively, P0.05), while squeeze time, pressure increase to cough, push relaxation, RAIR, rectal sensation, and EMG were comparable in males and females. Age negatively correlated with some anorectal parameters (table 1), simi- larly parity negatively correlated with anal resting (r=-0.52, p 0.05) and squeeze pressure (r=-0.56, p0.05). All subjects were able to expel the balloon. Conclusion: HRAM helps understanding anorectal physiology. It is influenced by age, gender, and parity. This study can aid in diagnosis anorectal dysfunc- tion in Egyptian population.

Purpose: The aim was to study High Resolution Anorectal Manometry (HRAM) in Egyptian population and the influence of age, gender and parity on manometric parameters. Methods: We studied 22 healthy volunteers 10 males and 12 females with median age 42 y (range: 18-61 y) by using solid state probe with 8 transducers 1 cm spaced with a rectal balloon mounted at the tip. The system is plotting graphs with high resolution topography and conventional pressure waves trac- ing as well (Solar GI MMS). Probe was introduced through the anal verge so the balloon is located at the rectum and the sensors at the rectum and analcanal. External EMG electrodes were applied on either sides of anus. Subjects were asked to relax, squeeze the anal sphincter, bear down, and cough to meas- ure anal pressures at these situations. Rectal sensation and recto-anal inhibi- tory reflex (RAIR) were evaluated by stepwise intermittent (10 ml) balloon distention. Finally balloon expulsion test was done. Results: Anal resting and maximum squeeze pressure were significantly higher in males than females (median; range: 61; 45-71 and 140.0; 67-224 vs. 42; 32-67 and 117; 58-220 respectively, P0.05), while squeeze time, pressure increase to cough, push relaxation, RAIR, rectal sensation, and EMG were comparable in males and females. Age negatively correlated with some anorectal parameters (table 1), simi- larly parity negatively correlated with anal resting (r=-0.52, p 0.05) and squeeze pressure (r=-0.56, p0.05). All subjects were able to expel the balloon. Conclusion: HRAM helps understanding anorectal physiology. It is influenced by age, gender, and parity. This study can aid in diagnosis anorectal dysfunc- tion in Egyptian population.

Purpose: The aim was to study the manometric patterns of systemic sclerosis (SS) by esophageal High Resolution Manometry (HRM). Methods: Fifteen patients with SS were studied with a solid state 32-channel esophageal HRM assembly (Solar GI MMS). Ten 5-ml water swallows were given with 30 sec apart. Studies were analyzed for resting LES tone, LES resid- ual pressure, peristalsis integrity, UES resting tone and UES residual pressure. The results compared with HRM data of 15 healthy volunteers. Results: Fifteen female patients, median age 48 y range (36-62) and disease duration 4.5 y (1-12). Controls were 7 males and 8 females median age 40 y (29-56). 33% had SS of cutaneous diffuse type, and 66% limited type. The main symptoms were dysphagia in 40%, heartburn 27%, and dyspepsia 13%. While 20% had no foregut symptoms. Manometric abnormalities were found in 66% of patients. 5 patterns of esophageal dysmotility were observed: Low LES tone with aperistalsis in 27%, low LES tone and UES tone with aperistalsis 13% (Fig- ure 1), aperistalsis 13%, (Figure 2) hypoperistalsis of proximal esophagus 7%, and low UES tone in 7%. Normal esophageal motility was reported in 33% [68] Table 1. Median (range) of manometric measurements of SS[68] Table 1. Median (range) of manometric measurements of SS LES tone mmHg LES residual mmHg LES length cm UES tone mmHg UES residual mmHg UES length cm Systemic sclerosis 15.5 (3-29) 4 (2–23) 2.3 (2–3.6) 47.5 (11–223) 4 (0–39) 2.3 (2–2.5) Control 24 (9–41) 4(−2 to 22) 2.8 (2.1–3.8) 67 (20–200) 5 (−2 to 16) 2.2 (1.9–2.7) P value 0.02 0.683 0.123 0.505 0.880 0.86 Median LES tone was significantly lower than that in controls (Table 1)while LES residual pressure, UES tone and residual pressure were comparable, simi- larly were LES and UES lengths. Conclusion: Esophageal manometric abnormalities are common in SS. Vari- ous segments of the esophagus are involved. The most common pattern is low LES tone and aperistalsis of the body.