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

Effect of Different Heparin Volumes on Blood Gas Analysis

AbstractBackground and Aim: Blood gas analysis is an important laboratory test for diagnosis and treatment of a variety of medical conditions in emergency rooms. Inaccurate sample collection is one of the reasons for errors in blood gas analysis. This study was conducted to evaluate different volumes of heparin in syringes and the effect of sample dilution on blood gas analysis as one of the main factors affecting the results of blood gas analysis.Methods: One hundred children (4 months to 12 years) who presented to Loghman Hakim Hospital, Tehran, Iran, were enrolled in this study. Two samples were taken from each patient. For the first sample, the syringes were filled with heparin sodium and then emptied completely to achieve a very thin layer anticoagulant coating. For the second sample, the syringes were filled with 0.1 mL of liquid heparin sodium 5000 U/mL (5%). The blood gas parameters including pH, PO2, PCO2, HCO3 and BE (base excess) were measured. Data were analyzed using SPSS version 18.Results: All parameter had lower levels in second samples (0.1 mL heparin 5%) except for PO2 compared to the first samples (P < 0.001).Conclusion: This study found that a small amount of heparin in the syringe changed the result of blood gas analysis. Keywords: Blood Gas Analysis; Heparin; pH; PCO2; HCO3

Efficiency of electrical coagulation process using aluminum electrodes for municipal wastewater treatment: a case study at Karaj wastewater treatment plant

Background: The reuse of treated municipal wastewater is an important source of water for different purposes. This study evaluated the efficiency of the electrocoagulation process in removing turbidity, total suspended solids (TSS), chemical oxygen demand (COD), nitrate, and phosphate from wastewater at the treatment facility in Karaj, Iran. Methods: This experimental study was performed at a pilot scale and in a batch system. A 4-liter tank made from safety glass with 4 plate electrodes made from aluminum was unipolarly connected to a direct current power supply with a parallel arrangement. Wastewater samples were taken from the influent at the Karaj wastewater treatment facility. Rates of turbidity, TSS, COD, nitrate, and phosphate removal under different conditions were determined. Results: The highest efficiency of COD, TSS, nitrate, turbidity, and phosphate elimination was achieved at a voltage of 30 volts and a reaction time of 30 minutes. The rates were 88.43%, 87.39%, 100%, 80.52%, and 82.69%, respectively. Conclusion: Based on the results of this study, electrocoagulation is an appropriate method for use in removing nitrate, phosphate, COD, turbidity, and TSS from wastewater

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

Prevalence of SHV gene and antibiotic resistance of extended-spectrum β-lactamase-producing Escherichia coli strains isolated from abattoir wastewater in Mazandaran Province, north of Iran

Abattoir wastewater is a major source of pollution burden and life-treating human pathogenic bacteria. The aim of this study was to determine the extended-spectrum β-lactamase-producing (ESBL) producing E. coli isolates and their antibiotic resistances in wastewater samples. In this experimental study, abattoir wastewater samples were collected and identified from 32 different regions in Mazandaran Province, North Iran. Disk agar diffusion test was applied for testing antibiotic resistance. Phenotypic detection of ESBL-producing isolates was performed using combined disk method. The presence of blaSHV gene was investigated using PCR method. The prevalence of E. coli in wastewater samples was 10%. The ESBL test analysis was positive for 14 (93.33%) isolates. The prevalence of blaSHV gene in ESBL-producing E. coli isolates was 93.34%. The highest antibiotic resistances in ESBL-producing E. coli were found concerning to ceftizoxime and gentamicin (100%), nalidixic acid, ceftazidime and ciprofloxacin (93.34%). Nitrofurantoin was the most effective antibiotic against E. coli isolate exhibiting the highest sensitivity (73.34%). In conclusion, the prevalence of ESBL-producing E. coli is high and being increased. The high prevalence of blaSHV gene in these isolates may be a reason for their pathogenesis and ability in transferring the resistance genes to multiple antibiotics. Therefore, there is a need to develop appropriate treatment and safer disposing abattoir wastes in this province

Antimicrobial Resistance Patterns of Probiotic Strains Isolated from Probiotic Yogurts of Iran

Background:     Probiotics mainly belong to Lactobacillus spp. and they are useful for humans in appropriate amounts. The present study aimed to determine antibiotic resistance patterns of such bacteria isolated from probiotic yogurts of Iran. Methods:     Probiotic bacteria were isolated from 7 yogurt samples and the isolates were identified by conventional methods and then confirmed using polymerase chain reaction (PCR) technique. Antibiotic susceptibility test was performed by disc diffusion test in order to determine isolates antibiotic resistance patterns. Results:      From 7 yogurt samples, 8 isolates were recovered and PCR assay also showed that the isolates belong to Lactobacillus delbrueckii subsp. bulgaricus. Antibiotic susceptibility testing showed that three isolates from three brands were resistant to vancomycin and gentamicin. Other strains were susceptible to all tested antibiotics. Conclusion:  Low resistance rate to antibiotics among Iranian probiotic bacteria indicate that the consumption of their products is safe but their clearance following antibiotic therapy can be unfavorable. Hence, applying probiotic strains with non-transferrable resistance elements in probiotic yogurts can be a useful strategy to make stable probiotic products

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

Factors Associated With High Blood Lead Levels in a Sample of 100 Children in Tehran

Background: Lead is considered a neurotoxic agent. We aimed to evaluate the blood lead level (BLL) in young population and determine probable risk factors of lead exposure in Iran. Methods: In a cross-sectional study, a total of 100 children were entered and their BLLs were checked. Results: In all, 25 and 8 patients had BLLs above 5 and 10 µg/dL, respectively. There was a significant univariate correlation between BLL and place of living, water pipe type, using dairy products, and stature in both cut-offs of 5 and 10 µg/dL. Binary regression analysis showed that pipe type was associated with high BLLs at cut-offs of 5 and 10 µg/dL, respectively. Also, there was an association between 50th percentile of stature for age and cut-off of 5 µg/dL. Conclusions: Higher BLLs may be seen in short stature pediatric population. Polyvinyl chloride (PVC) and polypropylene water pipes may even cause more release of lead and result in higher absorption of this metal in the pediatric population

Efficiency of electrical coagulation process using aluminum electrodes for municipal wastewater treatment: a case study at Karaj wastewater treatment plant

Background: The reuse of treated municipal wastewater is an important source of water for different purposes. This study evaluated the efficiency of the electrocoagulation process in removing turbidity, total suspended solids (TSS), chemical oxygen demand (COD), nitrate, and phosphate from wastewater at the treatment facility in Karaj, Iran. Methods: This experimental study was performed at a pilot scale and in a batch system. A 4-liter tank made from safety glass with 4 plate electrodes made from aluminum was unipolarly connected to a direct current power supply with a parallel arrangement. Wastewater samples were taken from the influent at the Karaj wastewater treatment facility. Rates of turbidity, TSS, COD, nitrate, and phosphate removal under different conditions were determined. Results: The highest efficiency of COD, TSS, nitrate, turbidity, and phosphate elimination was achieved at a voltage of 30 volts and a reaction time of 30 minutes. The rates were 88.43%, 87.39%, 100%, 80.52%, and 82.69%, respectively. Conclusion: Based on the results of this study, electrocoagulation is an appropriate method for use in removing nitrate, phosphate, COD, turbidity, and TSS from wastewater