21 research outputs found
Drug-Induced Apnea in Children Admitted to Loghman Hakim Hospital, Tehran, Iran
How to Cite This Article: Gholami N,Alwasabi F, Farnaghi F. Drug-Induced Apnea in Children Admitted to Loghman Hakim Hospital, Tehran, Iran. Iran J Child Neurol. Summer 2017; 11(3):15-18.AbstractObjectiveEnvironmental hazards, including poisons, can cause irreparable effects and even be fatal for children. Poisoning in children is common and serious, but often is preventable and treatable. This study aimed to evaluate the prevalence of drugs and chemical toxicity leading to apnea. In addition, we detected type of drug that induced apnea among children.Materials & MethodsIn a retrospective cross-sectional study from Apr 2012 to Apr 2013, sampled data of all hospitalized drug-induced apnea children were collected through hospital records.ResultsThe most common cause of drug toxicity was methadone syrup (74%). The mortality rate was 3.1%; all of them due to methadone poisoning.ConclusionThere was a high prevalence of apnea and poisoning of methadone in children.Methadone poisoning should be considered in apnea. References1. Sheikh NA, Damodar G. Spectrum of Accidental Paediatric Poisoning at a Tertiary Care Centre in South India. Medico-Legal Update 2015;15(1):93-7.2. Vasanthan M, James S, Shuba S, Abhinayaa J, Sivaprakasam E. Clinical profile and outcome of poisoning in children admitted to a tertiary referral center in South India. Indian J Child Health 2015;2(4):1-5.3. Jepsen F, Ryan M. Poisoning in children. Current Paediatr 15(7):563-8.4. Sharif MR, Nouri S. Clinical Signs and Symptoms and Laboratory Findings of Methadone Poisoning in Children. Iran J Pediatr 2015;25(1):e176.5. Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths--United States, 2000-2014. MMWR Morbidity and Mortality Weekly Report 2016;64(50-51):1378-82.6. Hein H, Puschel K, Schaper A, Iwersen-Bergmann S. [Accidental ingestion of methadone by children and suggestions for better prevention]. Archiv fur Kriminologie 2016;237(1-2):38-46.7. Boutroy MJ. Drug-induced apnea. Biol Neonate 1994;65(3-4):252-7.8. Farnaghi F, Hassanian-Moghaddam H, Faghihi Langroodi T. Fatal Poisoning and its Related Factors among Children Admitted in Loghman Hospital, 1995 -2004. Pajoohandeh J 2009;13(6):529-35.9. Fariba Farnaghi, Narjes Jafari, Fatemeh-Fereshteh Mehregan. Methadone Poisoning among ChildrenReferred to Loghman-Hakim Hospital in 2009. Pajoohandeh J 2012;16(6):299-303.10. Saleem A, Ejaz MS, Arif F, Hanifa A, Habib MI. Factors leading to acute accidental poisoning in children. Quarterly Medical Channel 2015.11. Farnaghi F, Pournasir Z, Tehranchi S. Opioid Poisoning in Children: A Report of 90 Cases. J Pediatr Nephrol 2015;3(2):62-6
Reliability of Urine Strip Test For Confirmation of Methadone Poisoning in Children
Introduction: Methadone is a drug with biologic effects similar to morphine which acts via interacting with major classes of receptors  κand µ. It has a half-life of 25 to 50 hours. Ingestion of this substance causes serious symptoms such as bradycardia, apnea, decreased level of consciousness, and death. Rapid diagnosis and treatment is life-saving. The methadone urine test is an easy to perform test which could detect the substance rapidly. This study was conducted to determine the reliability of the positive methadone urine test in the first and second days of poisoning in children below the age of 13 who have been poisoned with it.Materials and Methods: A total of 50 children below 13 years of age were enrolled in the study from April 2013 to April 2014. They were referred to Loghman Hakim Hospital with a history of incidental methadone ingestion and clinical symptoms congruent with methadone poisoning such as apnea, drowsiness, decreased level of consciousness, and bradycardia and miosis. Methadone urine strip test was performed on the first and second days. Five parameters (age, gender, dose of ingested methadone, urine SG, and urine pH) were tested and recorded for each patient.Results: This test is an accruable test for the detection of methadone (P value<0.05). Findings suggested that as little as 2 mg of methadone administration could lead to a positive urine test. The highest frequency of positive test was observed when the test was given between 6 to 12 hours after methadone ingestion and the lowest frequency was obtained in the first 6 hours after poisoning. It is suggested that the test result can be false negative if it is carried out in less than 6 hours after methadone consumption.Conclusions: According to the results of this study, the methadone urine drug screen test has high accuracy for detection of methadone in the urine. In addition, if the initial test result is negative in the first 24 hours, we recommend that the test should be repeated 24 hours after the ingestion; thus, two negative results in the first 48 hours of ingestion can rule out methadone poisoning by a probability of 98.5%.Keywords: Poisoning; Urine Test; Methadone; Child
Antipsychotic Drug Poisoning in Children Under 12 Years Old in Loghman-Hakim Hospital During 2016-2022
Background: Unintentional pediatric poisoning with antipsychotic medications represents an important clinical entity. This study aimed to evaluate the epidemiology, clinical manifestations, and outcomes of antipsychotic poisoning among children presenting to a referral hospital.Methods: This descriptive, cross-sectional study reviewed medical records of children <12 years old hospitalized for antipsychotic drug poisoning at Loghman Hakim Hospital in Tehran from 2015-2016. Data extracted included demographic details, agent and dose ingested, clinical findings, treatments administered, and patient dispositions.Results: 141 cases were identified, comprising 2.3% of all pediatric poisonings. Patient ages ranged from 6 months to 12 years (mean 5.5 years), with a male predominance (52.5%). The most common offending agents were risperidone (53.2%) and olanzapine (13.4%). Unintentional exposures accounted for 72.3% of cases. Central nervous system (CNS) effects like somnolence (61.7%) and dysarthria (19.1%) were most prevalent. Significant toxicity was infrequent; no fatalities occurred. Mean length of stay was 2 days for uncomplicated admissions. Conclusion: Antipsychotic poisoning in children chiefly involves atypical agents with a largely benign course. Risperidone predominated due to prescribing patterns. Somnolence represented the principal clinical manifestation. With reasonable supportive care, favorable outcomes are achievable in the pediatric population
Opioid Poisoning in Children: A Report of 90 Cases
Introduction: The opioid overdose epidemic is a worrying and considerable public health problem in many countries. A few studies have been done in children about opioid poisoning. The aim of this study was to explain the clinical symptoms and laboratory findings of opioid poisoning and the associated complications among children.Material and Methods: This prospective cross-sectional study was conducted on 100 children under 14 years of age who were poisoned with opium, tramadol, buprenorphine, methadone, and diphenoxylate and admitted to Loghman-Hakim Hospital, a major center for poisoning treatment in Tehran, Iran, from April 2011 to April 2012. The exclusion criteria were a history of musculoskeletal diseases, concurrent ingestion of other drugs, intramuscular injection, and a history of trauma. The clinical presentation and renal and electrolytes complications were recorded.Results: Finally, 90 out of 100 admitted children were eligible to be included in the study, 64 boys and 26 girls (median age: 40.3 ± 32 months, range: 1 month to 11 years old). The minimum duration of admission was 1 day and the maximum was 29 days with a mean of 2 days. The major opioid substance was methadone. The most common symptom was decreased consciousness followed by bradypnea. The incidence of opioid- induced rhabdomyolysis was 2.2% but none of the them were complicated with acute renal failure or electrolyte disturbance.Conclusions: Concerning this study, we recommend attention to muscle enzymes elevation and preventive spadework for its complications in children poisoned with opoiods.Keywords: Opium; Poisoning; Rhabdomyolysis; Acute Kidney Injury; child.
Hemorrhagic Cystitis Following Cephalexin Overdose in a Child.
How to Cite This Article: Pournasiri Z, Farnaghi F, Mehregan F, Tehranchi ST. Hemorrhagic Cystitis Following Cephalexin Overdose in a Child. J Ped. Nephrology 2013 July;1(1):37-38Â Hemorrhagic Cystitis (HC) is an infectious or noninfectious process that leads to gross hematuria originating from the urinary bladder mucosa. A previously healthy 2.5-year-old boy was referred to our center five hours after ingestion of 120 ml (6 g) of cephalexin suspension with abdominal pain, diarrhea, vomiting, and gross hematuria. The results of the general physical examination were unremarkable except for mild suprapubic tenderness. He was admitted to the hospital and hydrated.Laboratory tests on admission showed normal CBC & electrolytes, normal PT&PTT, negative coombs test, many RBCs per high-power field (HPF) in the urine, and normal urinary tract sonography. Within 24 hours, the urine cleared, showing only 1 to 2 red blood cells per high power field with no changes in the CBC, electrolytes, or kidney function tests. His urine culture was negative. Although there are reports of antibiotic- induced HC, the rarity of cephalosporins and cephalexin induced hemorrhagic cystitis encouraged us to report this observation. Keywords: Cystitis; Hematuria; Cephalexin; Poisoning; Child
The evaluation level of carboxyhemoglobin in children blood with chief complain of headache, nausea, and dizziness referring to pediatric clinics of Loghman hakim hospital in year 2018-2019
Carbon monoxide poisoning is common, challenging and serious poisoning with wide range of non-specific flu-like clinical manifestations that leads to misdiagnosis. This cross-sectional descriptive controlled study conducted in Loghman Hakim Hospital on 3-14 year-old patients presenting with non-specific Flu-like (headache, dizziness, nausea, vomiting, malaise) symptoms from November 2018 to May2019. In all subjects carboxyhemoglobin level measured via noninvasive pulse CO-oximetry (Massimo Company, USA). Demographic data, cigarette, shisha, opium smoke exposure, type of home heater, carboxyhemoglobin level were collected and statistically analyzed via SPSS v16.0. A total of 93 children 3-14 year-old were enrolled the study. Their mean age was 4.6+4.3 years, 46% were male and54% female. Mean carboxyhemoglobin level was 27.8+9.7 %( range 2.7% to 44%). The most frequently encountered symptoms were nausea &vomiting (44%), dizziness (36%), headache (32%) and myalgia (23%). We obtained the COHb levels using noninvasive pulse oximeter for all study patients and their mother, and the levels > 5% for non-smokers were considered as CO poisoning. Of the 93 study patients, 49%had normal carboxyhemoglobin levels (CoHb level< 5%). Of the remaining 51% study patients, 47 patients had CoHb levels between 5% and 10%, and seven patients > 10%. Closer attention to early and nonspecific signs and symptoms of Carbon Monoxide poisoning and higher clinical suspicion could reduce the rate of misdiagnosis and therefore minimize complications in this serious poisoning
An Epidemiologic Study of Pediatric Poisoning; a Six-month Cross-sectional Study
Introduction: Intentional and unintentional poisoning are among the most common reasons for referrals to emergency department (ED). Therefore, the present study was designed to evaluate epidemiologic features and effective risk factors of intentional and unintentional poisoning in children. Methods: This prospective cross-sectional study was carried out in ED of Loghman Hakim Hospital, greatest referral poison center of Iran, Tehran during March to August 2014. Demographic data, medical history, history of psychiatric disease in child, the cause of poisoning, parents’ educational level, household monthly income, location of residence, history of addiction or divorce in family, and the poisoning intentionality were gathered. Data were analyzed using SPSS 18 and appropriate statistical tests based on the purpose of study. Results: 414 participants with the mean age of 4.2 ± 3.43 years were included (57.5% male). Children in the 0-4 year(s) age range had the most frequency with 281 (67.9%) cases. 29 (7%) cases were intentional (62% female, 76% in the 10-14 years old group). Methadone with 123 (29.7%) cases was the most frequent toxic agent in general and in unintentional cases. 10-14 years of age (p = 0.001), and the history of psychiatric disease in children (p <0.001), had a direct correlation with probability of intentional poisoning. While, history of addiction in the family showed an indirect correlation with this probability (p = 0.045). Conclusion: Based on the results of this study, most cases of poisoning in the children were unintentional methadone intoxication in boys in the 0-4 age range with a history of a psychiatric disease, and those who had a history of addiction in the family. In addition, the most powerful risk factor for the children’s intentional poisoning was their history of psychiatric disease. The history of addiction in the child’s family had indirect correlation with intentional intoxications
Accidental Children Poisoning With Methadone: An Iranian Pediatric Sectional Study
How to Cite This Article: Jabbehdari S, Farnaghi F, Shariatmadari SF, Jafari J, Mehregan FF, Karimzadeh P. Accidental Children Poisoning With Methadone: An Iranian Pediatric Sectional Study. Iran J Child Neurol. 2013 Autumn;7(7): 32-34.ObjectiveToxic poisoning with methadone is common in children in Iran. Our study was carried out due to the changing pattern of methadone poisoning in recent years and increasing methadone toxicity. Materials & MethodsIn this descriptive-sectional study, all of the methadone poisoned children younger than 12 years who were admitted to the Loghman Hakim Hospital in 2012, were assessed. Clinical symptoms and signs, para-clinical findings, and treatment were evaluated. ResultsIn this study, 16 boys and 15 girls who had been poisoned by methadone were enrolled. The mean age of patients was 55 months. All patients had been poisoned randomly or due to parent’s mistakes. The mean time of symptoms onset after methadone consumption was 1 hour and 30 Min, indicating a relatively long time after onset of symptoms.Clinical findings were drowsiness (75%), miotic pupil (68 %), vomiting (61%), rapid shallow breathing (57%) and apnea (40%). In paraclinical tests, respiratory acidosis (69%) and leukocytosis (55.2%) were seen. The most important finding was increase in distance of QT in ECG (23.8%). The mean time of treatment with naloxone infusion was 51 hours. Three percent of patients had a return of symptoms after discontinuation of methadone. In patients with apnea, a longer course of treatment was required, and this difference was significant. Also, 17% of patients with apnea had aspiration pneumonia, which was statistically significant. ConclusionWe suggest long time treatment with naloxone and considering the probability of return of symptoms after discontinuation of methadone.ReferencesGoldfrank L, Flomenbaum N, Lewin N. Goldfrank’s Toxicologic Emergencies. 7th ed. McGraw–Hill 2002; p. 590-607.Schelble DT. Phosgene and phosphine. In: Haddad LM, Shannon MW, Winchester J, eds. Clinical Management of Poisoning and Drug Overdose. 3rd ed. Philadelphia: WB Saunders; 2007. p. 640-7.Jennifer C, Gibson A. Accidental methadone poisoning in children: A call for Canadian research action. Child Abuse Negl;2010;34(8):553-4.Binchy JM, Molyneux E, Manning J. Accidental ingestion of methadone by children in Merseyside. BMJ 1994;308(6940:1335-6.Zamani N, Sanaei-Zadeh H, Mostafazadeh B. Hallmarks of opium poisoning in infants and toddlers. Trop Doct 2010;40(4):220-2.LoVecchio F, Pizon A, Riley B, Sami A, D’Incognito C. Onset of symptoms after methadone overdose. Am J Emerg Med 2007;25(1):57-9.Thanavaro KL, Thanavaro JL. Methadone-induced torsades de pointes: a twist of fate. Heart Lung 2011;40(5):448-53.Gaalen FA, Compier EA, Fogteloo AJ. Sudden hearing loss after a methadone overdose. Eur Arch Otorhinolaryngol 2009;266(5):773-4.Lynch RE, Hack RA. Methadone-induced rigid-chest syndrome after substantial overdose.Pediatrics. 2010; 126(1):232-4.Sidlo J, Valuch J, Ocko P, Bauerová J. Fatal methadone intoxication in a 11-month-old male infant. Soud Lek 2009;54(2):23-5.
Blood lead level and related factors in ADHD patients of Loghman Hakim Hospital in 2016- 2017
Introduction: Lead is a highly neurotoxic metal mainly in early life. In this study we investigate blood lead level (BLL) in children with attention deficit/ hyperactivity disorder (ADHD) and some related factors mainly opium exposure, as a source of lead exposure in recent years in Iran.
Materials and Methods: In this cross-sectional descriptive study children & adolescents aged < 18 years in Child Neurology Clinic of Loghman Hakim hospital with ADHD criteria according to DMS-V in Tehran-Iran were studied. Lead Care II checked BLLs using 0.5-milliliter heparinzed venous blood. Demographics characteristic and some related factors such as old housing, parents’ job, pica, opium exposure were asked and analyzed.
Results: Fifty-one children and adolescents <18 years, 25.5% female and 74.5% male with mean ages of 71.4+30.3 months entered the study. Mean BLL was 6.34+2.63 µg/dl. The mean BLL in 100 normal children in Loghman Hakim hospital was 3.4 µg/dl. Mean BLL was 57/6 µg/dl in boys and60/6 µg/dl in girls, (p=0.973). Also, the difference in mean BLLs were not significant in terms of living place, sex, age, pica and parents job. Totally, 43 patients (84.3%) of the study samples had BLL ≥5 µg/dl. The highest blood lead level in our patient was 20.1 µg/dl. Eighteen (32.7%) of our patients have positive history for opium exposure in their family that BLL in this group was 5.84 µg/dl in comparison 6.95 µg/dl in cases with no opium exposure, that there were not statistically significant. (p=0.148)
Conclusion: Based on the results of our study, clinicians are encouraged to take accurately attention about possible lead exposure and to rule out environmental hazards when evaluating for ADHD, particularly in young children and laboratory investigation for this toxin in high-risk cases and further researches recommende
Assessment of COVID-19 among healthcare workers in Non-COVID pediatrics departments, Tehran, Iran: A cross-sectional study
Objective: The severe acute respiratory syndrome coronavirus 2(SARS COV 2) is an important health problem, which is widespread around the world. This study describes the characteristics of COVID-19 infections in healthcare workers (HCWs), related factors and deaths in Non- COVID pediatrics departments from the early phases of COVID-19 pandemic; February 20th, 2020toJanuary19th, 2021 in Tehran-Iran.
Materials and Methods: It is a multi-center cross-sectional descriptive study. The standardized questionnaire was designed according Demographics information, Coronavirus disease (COVID-19) history in HCW and Using and access to Personal Protective Equipment (PPE). All data analysis was performed by SPSS software version 21.
Results: Of the 82 HCW, 67 (81.7%) was female. The median age was 37.6 ±10.3 years old (rang 24 to 65). 44 (53.6%) were nurses, 14 (17 %) pediatrics residents,13 (15.9%) pediatrics faculty members,8(9.8%) environmental services staff and 3(3.7%) secretaries. Twelve out of our cases (14.6%) have underlying medical diseases. Thirty-six (42.7%) confirmed COVID19. In COVID-19 positive group 28(80%) were female. Among whom 51.4% were identified nurses, 17% faculty member and14.3% pediatrics residents. Secretaries and environmental services staff are more vulnerable job category in this study. Eighty-six percent of them follow protective health protocol and use PPE. COVID-19 cases were infected more on July 2020(25.7%), November 2020 (17.1%) and August 2020(14.2%).
Conclusion: Approximately one half of HCWs in non-Covid-19 pediatrics department infected with corona virus 2 (SARS_COV_2) and most of them thought they were infected in workplac