Clinical and Socioeconomic Factors Associating with Opium Poisonings in Children and Adolescents

Background: Use of opium and derivatives is one of the major health, psychosocial and socioeconomic problems and can lead to complications for societies. The present study aimed to assess clinical and socioeconomic factors associated with the poisonings by Opium and its Derivatives (O&D) in children and adolescents. Methods: This retrospective study was carried out to review the recorded clinical information of children and adolescents admitted to the pediatric emergency department of the Ali Ibn Abi Talib Hospital due to acute poisoning by O&D during a seven-year period since 2014. Demo-economic information was taken from the patient’s guardians at the time of discharge. Collected data were analyzed by SPSS 20 considering 0.05 as the significant level. Results: From among 227 poisoned children, 50.7% were female and 75.8%, 8.8% and 15.4% were in age groups of <8 year, 8-12 and 12-18 years, respectively. About 42.7% of the children poisoned by industrial substances, compared to the traditional substances. Respectively, 87.7%, 11% and 1.3% of the children were poisoned accidentally, intentionally, and due to family challenges or schooling problems. Variables of the children’s gender, age, and father’s age were associated with self-poisoning. The samples’ heart rate, blood pressure and seizure were affected by the type of narcotic. Conclusion: Overall, the majority of poisoned children were girls and young. Those with very young and very old parents had more tendency to self-poison due to family challenges. Types of narcotic substances significantly correlated with irregular changes in the size of the pupil, heart rate, blood pressure and seizure

Quality of Life in Children and Adolescents with Congenital Heart Diseases in Zahedan, Iran

BackgroundLife expectancy has increased in congenital heart diseases (CHD) patients and the interest has risen considering the quality of life (QOL). The study aimed to compare patients and proxy-parents reports on CHD children' QOL.Materials and MethodsThis cross-sectional study performed on 165 CHD patients aged 2-18 years during 2016 using Pediatric Quality of Life 3.0 (PedsQL™ 3.0) inventory. PedsQL™ 3.0 has same dimensions with different question for various age groups. The internal consistency of the inventory scales and subscales was assessed by means of Cronbach’s alpha. Scales with reliability ≥ 0.70 were recommended.ResultsThe overall mean score of QOL was significantly higher in parents’ perceived (51.78±10.87) compared to children’s perceived (48.61±11.25) (t= -2.615, P=0.009). The anxiety was significantly higher (56.23 ±17.93 vs. 47.31± 17.96) in parents’ perceived compared to children (t= -2.281, P=0.025). The cognition has been perceived significantly better by children than parents’ (51.22±15.76 vs. 41.53± 13.15). Children with simple diseases had higher score of quality of life (53.09±13.44) compared with those children with complex diseases (42.73±18.23) (t=2.786, P=0.007) for 2-4 years age in parents' perceived. The mean scores in heart problem scale were 46.74±13.64 and 61.14±18.17 and for the communication scale were 28.49±13.87 and 41.77±20.23 for pre and post operated children respectively for the age group of 5-7 years in parents' perceived.ConclusionResulted no impacts by two clinical (types of diseases and operation) factors on CHD patients' Health-related quality of life (HRQOL). Therefore should be considered more clinical factors to detect the gap in QOL in CHDs

Comparison of Right and Left Side Heart Functions in Patients with Thalassemia Major, Patients with Thalassemia Intermedia, and Control Group

Background: Heart disease is the main cause of mortality and morbidity in patients with beta thalassemia, rendering its early diagnosis vital. We studied and compared echocardiographic findings in patients with beta thalassemia major, patients with beta thalassemia intermedia, and a control group. Methods: Eighty asymptomatic patients with thalassemia major and 22 asymptomatic cases with thalassemia intermedia (8-25 years old) were selected from those referred to Ali Asghar Hospital (Zahedan-Iran) between June 2008 and June 2009. Additionally, 80 healthy individuals within the same age and sex groups were used as controls. All the individuals underwent echocardiography, the data of which were analyzed with the Student t-test. Results: The mean value of the pre-ejection period/ejection time ratio of the left ventricle during systole, the diameter of the posterior wall of the left ventricle during diastole, the left and right isovolumic relaxation times, and the right myocardial performance index in the patients with beta thalassemia major and intermedia increased significantly compared to those of the controls, but the other parameters were similar between the two patient groups. The mean values of the left and right pre- ejection periods, left ventricular end systolic dimension, and left isovolumic contraction time in the patients with thalassemia intermedia increased significantly compared to those of the controls. In the left side, myocardial performance index, left ventricular mass index, isovolumic contraction time, and deceleration time exhibited significant changes between the patients with thalassemia major and those with thalassemia intermedia, whereas all the echocardiographic parameters of the right side were similar between these two groups. Conclusion: The results showed that the systolic and diastolic functions of the right and left sides of the heart would be impaired in patients with thalassemia major and thalassemia intermedia. Consequently, serial echocardiography is suggested in asymptomatic patients with beta thalassemia for an early diagnosis of heart dysfunction and proper treatment

Diagnostic Value of Electrocardiography Compared with Echocardiography in Measuring Left Ventricular Mass Index in Major Thalassemia Patients Over 10 Years of Age

Background: Patients suffering from major beta thalassemia need frequent blood transfusions and, if not treated well, would be at risk of heart dysfunction. This study was performed to determine the diagnostic value of electrocardiography versus echocardiography in measuring the left ventricular mass index in these patients. Methods: Between July 2010 and June 2011, 82 asymptomatic patients over 10 years of age with major thalassemia (42 men with a mean age of 17.65 ± 3.39 years and 40 women with a mean age of 16.9 ± 3.38 years) were enrolled in this study. For all the patients, standard electrocardiography (to measure R in aVL and S in V3 and calculate left ventricular mass index by electrocardiography) and echocardiography (to measure interventricular septum diameter in diastole, left ventricular posterior wall diameter in diastole, and left ventricular diameter in diastole in order to calculate left ventricular mass index by echocardiography) were performed, at least one week after transfusion. The calculated left ventricular mass indices were thereafter compared between the two methods (electrocardiography and echocardiography). Results: Sensitivity, specificity, positive predictive value, and negative predictive value in the two techniques in determining the left ventricular mass index were 67%, 25%, 89%, and 7% in the females, 65%, 33%, 92%, and 6% in the males, and 67%, 14%, 89%, and 3% in the total population, respectively.  Furthermore, this study demonstrated that the average left ventricular mass index by echocardiography and electrocardiography was 104.86 ± 21.65 gr/m2 and 91.69 ± 12.03 gr/m2, respectively. Echocardiography was much more accurate than electrocardiography in determining the left ventricular mass index (p value = 0.0001). Conclusion: The findings of this study demonstrated that echocardiography was more accurate and more reliable than electrocardiography in determining the left ventricular mass index in major thalassemia patients

Long-Term Results of Transcatheter Closure of Patent Ductus Arteriosus in Infants Using Amplatzer Duct Occluder

Objective: Patent ductus arteriosus (PDA) is one of the most frequently seen congenital heart diseases. Its closure is recommended because of the risk of infective endocardis, as well as morbidity and mortality in the long. The aim of this study was to assess the long term results of the transcatheter closure of PDA in infants using amplatzer duct occlude (ADO). Methods: From May 2004 to September 2011, forty eight infants underwent transcatheter closure of PDA. A lateral or right anterior oblique view aortogram was done to locate PDA and to measure its size. Before discharge, repeat aortogram was performed to evaluate eventual residual shunt and to confirm the appropriate deployment of the ADO. Follow up evaluations were done with transthoracic echocardiography at discharge, 1 month, 6 months, 12 months and yearly thereafter. Findings: The mean age of patients at procedure was 9.18±2.32 (range 3 to 12) months, mean weight 6.73±1.16 (range 4.5 to 10.1) kg. The PDA occluded completely in 20 out of the 48 patients. Twenty four patients had trivial or mild shunt and two patients had moderate residual shunt which disappeared in one patient within 24 hours and other patient with moderate shunt in 1 month. One patient (age 8 months) had mild LPA stenosis. The device emobolization occurred in two patients, immediately after the procedure in one and during night in the other patient Conclusion: The long term results suggested that transcatheter closure of PDA using Amplatzer duct occluder is a safe and effective treatment in infants less than 1 year of age with minimal complications