Cantharidin Poisoning due to Blister Beetle Ingestion in Children : Two case reports and a review of clinical presentations

Cantharidin is an intoxicant found in beetles in the Meloidae (Coleoptera) family. Ingestion may result in haematemesis, impaired level of consciousness, electrolyte disturbance, haematurea and renal impairment. Here, we report two paediatric cases of meloid beetle ingestion resulting in cantharidin poisoning and the clinical presentation of the ensuing intoxication

Cause-Specific Neonatal Mortality at the Armed Forces Hospital, Southern Region Khamis Mushayt, Kingdom of Saudi Arabia

Abstract Objective: To document the perinatal and neonatal characteristics in a single hospital setting, to identify the main causes of neonatal deaths and to review the trends in neonatal mortality over a 6-year period. Methodology: This is a 6-year retrospective analysis of perinatal and neonatal data at the Armed Force Hospital, Southern Region, Saudi Arabia. Results: During the study period, there were 3 7,3 84 births resulting in 4,352 (11%) admissions to the neonatal intensive care unit (NICU). The average stillbirths rate was 54/1000 of the total births, and perinatal mortality rate was 9.6/1000 live births. Of the total NICU admissions, 2,698 (62%) were preterm, low-birth-weight (LBW) babies and 234 (5.4%) were extreme low birth-weight neonates (ELBW<1000gm). Overall neonatal mortality was 5.3% of the total admissions. Mortality rate was highest among ELBW babies (n=85; 36%). Prematurity-related conditions and multiple congenital anomalies accounted for the majority of deaths in the unit (61% and 44%, respectively), followed by birth asphyxia (10%). In ELBW infants, respiratory failure (45%) and grade IV intraventricular hemorrhage (40%) were the leading causes of early deaths, while sepsis accounted for 50% of late neonatal deaths. The mortality rate was significantly lower for larger neonates (10% for 1000-1500gm birth weight infants and only 3.3% of near-term neonates above 1500gm). The major cause of death was respiratory failure in smaller babies (52%) and multiple congenital anomalies in near-term infants. The presence of multiple congenital anomalies and extreme prematurity were the major contributing factors to neonatal mortality. Conclusions: There is a pressing need to study neonatal mortality to ascertain the cause of neonatal deaths in the Kingdom of Saudi Arabia

Repeated Mechanical Endovascular Thrombectomy for Recurrent Large Vessel Occlusion: A Multicenter Experience

BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is now the standard of care for large vessel occlusion (LVO) stroke. However, little is known about the frequency and outcomes of repeat MT (rMT) for patients with recurrent LVO. METHODS: This is a retrospective multicenter cohort of patients who underwent rMT at 6 tertiary institutions in the United States between March 2016 and March 2020. Procedural, imaging, and outcome data were evaluated. Outcome at discharge was evaluated using the modified Rankin Scale. RESULTS: Of 3059 patients treated with MT during the study period, 56 (1.8%) underwent at least 1 rMT. Fifty-four (96%) patients were analyzed; median age was 64 years. The median time interval between index MT and rMT was 2 days; 35 of 54 patients (65%) experienced recurrent LVO during the index hospitalization. The mechanism of stroke was cardioembolism in 30 patients (56%), intracranial atherosclerosis in 4 patients (7%), extracranial atherosclerosis in 2 patients (4%), and other causes in 18 patients (33%). A final TICI recanalization score of 2b or 3 was achieved in all 54 patients during index MT (100%) and in 51 of 54 patients (94%) during rMT. Thirty-two of 54 patients (59%) experienced recurrent LVO of a previously treated artery, mostly the pretreated left MCA (23 patients, 73%). Fifty of the 54 patients (93%) had a documented discharge modified Rankin Scale after rMT: 15 (30%) had minimal or no disability (modified Rankin Scale score ≤2), 25 (50%) had moderate to severe disability (modified Rankin Scale score 3-5), and 10 (20%) died. CONCLUSIONS: Almost 2% of patients treated with MT experience recurrent LVO, usually of a previously treated artery during the same hospitalization. Repeat MT seems to be safe and effective for attaining vessel recanalization, and good outcome can be expected in 30% of patients

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study\u27s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p\u3c0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p\u3c0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction

Drowning in children: Aseer Central Hospital experience, Southwestern Saudi Arabia

Aim: To study the reasons, magnitude and outcome of drowning following submersion in water of children admitted to the Pediatric Intensive Care Unit in Aseer Province, Saudi Arabia. Materials and Methods: A retrospective cohort study of all pediatric patients (0-13) years old who drowned and were admitted to the Pediatric Intensive Care Unit, Aseer Central Hospital, Southwestern Saudi Arabia, between January 1st 1999 and December 31st 2009. Results: A total of 19 cases were admitted following submersion in water. The mean age was 5.2 years ±3.8. Majority of victims (94.1%) were from the highland areas. Events most frequently occurred in the summer (46.7%), followed by spring and winter, 33.3% and 20%, respectively. Home events constituted 44.4% of submersion cases. Of these, 55.6% drowned in a washing container, While 53.4% submersed in swimming pools. Twenty-two percent of these accidents occurred in the sea and in wells while 11.1% occurred in a lake. The mean duration of submersion was 4.04 minutes ± 5.35. Cardiac arrest was reported upon arrival at hospital in 42.1% of the victims. There were seven deaths (36.8 %) and in one patient (5.2 %) there was severe brain injury. In all deceased cases, no adults were watching the children when the accidents occurred. Conclusion: Drowning is a significant risk factor facing our children and can claim lives. The media as well as the authority should play a major role in increasing the public awareness to minimize or prevent such a problem

Nifedipine-induced Hyperglycaemia in an Infant: Case Report.

This case report describes reversible hyperglycaemia in a severely ill six-month old Saudi boy treated with nifedipine for hypertension. Hyperglycaemia became manifest on the second day of treatment with nifedipine and was not dose-related. Following discontinuation of the drug, the patient rapidly became euglycaemic. It is concluded that the hyperglycaemia was induced by nifedipine. This side effect of nifedipine has been reported in adults but the present case would appear to be the first of a similar report in a child. We suggest that dehydration due to hyperglycaemia-induced osmotic diuresis can constitute a risk to small infants on nifedipine, hence it should be used with caution on outpatient basis Nigerian Journal of Paediatrics 2001;28:18. pp. 18-2

Larvicidal and repellent effect of some Tribulus terrestris L., (Zygophyllaceae) extracts against the dengue fever mosquito, Aedes aegypti (Diptera: Culicidae)

Aedes aegypti transmits etiologic agents of yellow fever and dengue. Vaccine for dengue virus is not available and vector control is essential to minimize dengue incidence. The larvicidal and repellent effect of the crude ethanol, acetone and petroleum ether extract leaves of Tribulus terrestris, against 3rd instar larvae and adults of mosquito, Ae. aegypti the vector of dengue fever was evaluated. The efficacy of petroleum ether extract seemed to be more effective with LC50 64.6 ppm followed by acetone extract with LC50 173.2 ppm and finally ethanolic extract with LC50 376.4 ppm. Moreover, the acetone and petroleum ether extracts exerted a highly delayed toxic effect on the pupae and adults resulted from treated larvae, where the pupal mortality was 57.1% and 100% at concentrations 400 and 100 ppm, respectively. Also, the petroleum ether and acetone extracts showed reduction effects on adult emergence. The repellent action of the plant extracts tested was varied depending on the solvent used in extraction and the dose of the extract. The most effective plant extract that evoked 100% repellency or biting deterrence was petroleum ether extract at a dose of 1.5 mg/cm2 compared with 100% repellency for commercial formulation, N,N-diethyl-3-methylbenzamide (DEET) at the same dose. Hence, these extracts can be used as an effective alternative to the existing synthetic pesticides for the control of Ae. aegypti