Recurrent Syncope following Substance Abuse; a Case Report

Drug abuse is considered as the most common poisoning in the world. Stimulants agent especially amphetamines and methamphetamines are among important abused substances. Different types of neurologic, psychiatric, respiratory, gastrointestinal, and cardiogenic complications have been reported to be related to methamphetamine consumption. Some of these substances could cause dysrhythmias which is the most prevalent etiology of cardiogenic syncope. Ecstasy, as one of the most commonly abused drugs, is known as a cause of cardiac dysrhythmias. Here we report a young boy who was admitted into the emergency department following three syncope attacks. All cardiac and neurologic assessments were normal; and finally ecstasy abuse was detected as the main etiology of syncopes

Approach to Chronic Secondary Headache: A Case Report on Unusual Drug Side Effects

In this article, we present the case of a 12-year-old female child who complained of bilateral temporal and frontal headache for 2 to 3 months with nausea and vomiting. Physical examination revealed right-sided sixth cranial nerve palsy and papilledema in ophthalmoscopy. To find the cause of increased intracranial pressure, the patient underwent brain imaging and brain MRI showed no abnormality. Ultimately, lumbar puncture (LP) was performed and cerebrospinal fluid (CSF) pressure was 280 mmH2O with normal chemistry. We considered pseudotumor cerebri as the first diagnosis. LP was carried out three times and 30cc of CSF was tapped each time. Finally, patient’s headache and papilledema improved and physical examination after 6 months showed no sign of raised intracranial pressure (rICP). The most prominent point in her past medical history was the use of growth hormone (GH) for 2 years. No sign of symptom relapse has been seen after 6 months of drug discontinuation. We must consider the hazard of growth hormone as a potential cause of increased intracranial pressure. When the use of GH is justified, the follow-up must include an ophthalmoscopy examination in each session

Complications of Corrective Surgery in Preterm Neonates with Congenital Heart Defects: What is the Solution?

Mild congenital heart defects require no treatment, while severe forms of these diseases need immediate interventions. There are several limits in preterm neonates on drug interventions, interventional procedures, and even heart surgery due to the prematurity of pulmonary, renal, and central nervous systems. Considering the mentioned points, the collaboration of other medical professions, particularly neonatologists, is needed in the treatment of these newborns. The application of surgical and interventional instruments are associated with limitations owing to the low birth weight in these neonates. Therefore, it is essential to review and modify the treatment program for this group of patients. By the advancement of surgical treatments mainly in fetal course and the approval of their efficiency, designing a new interdisciplinary field is necessary. In developing countries, such as Iran, the prenatal diagnosis of congenital heart diseases is difficult because of the lack of expertise in this area. On the other hand, abortion seems to be problematic due to the religious reasons. The legal gestational age for abortion is less than 20 weeks, and the probability of dealing with these kinds of diseases is more than developed countries. During several years, we encountered at least 15 cases with the above-mentioned criteria, five of whom required an immediate intervention. Three patients were dextro-Transpotion of the great arteries, one patient had pulmonary atresia with ventricular septal defect, and the two other ones were suffering from coarctation of the aorta and tricuspid atresia type 1A, who all underwent the palliative surgery

Effectiveness of Coenzyme Q10 on echocardiographic parameters of patients with Duchenne muscular dystrophy

Background: Myocardial damage is a common complication in patients with Duchenne muscular dystrophy (DMD) that occurs due to myocardial replacement by fat and fibrosis. In recent years, efforts have been made toward finding new pharmacological agents with fewer complications which can be used as prophylactic before the symptoms. Coenzyme Q10 plays a central role in production of bioenergy in heart muscle and antioxidant in reperfusion condition of myocardial damaged muscle and leads to membrane stability and prevents cell death. Objective: This study aimed at comparing the Effectiveness of coenzyme Q10 on echocardiographic parameters of pediatric patients with Duchenne muscular dystrophy. Methods: This randomized clinical trial study (RCT) was carried out on 25 pediatric patients with pre-diagnosed DMD who attended the Children’s Medical Center (CMC), Tehran, Iran from February 2013 to 2015. The patients were randomly divided into two groups. Group-1; (n=12) was treated with coenzyme Q10 for six months and group-2 ;(n=13) received placebo for the same time. The primary aim was to compare the myocardial performance index (MPI), between the two groups at the end of six months. Data were analyzed by SPSS software (ver-16) and using T-Test. Results: Twenty-five patients under study were divided into two groups of (Q10=12) and (placebo=13). Mean ages were 8.9±1.7 and 8.6±1.4 in Q10 and placebo groups (P=0.66). No significant difference was detected in MPI at all three views of mitral and tricuspid and septum respectively in two groups after the end of treatment (0.41±0.13, and 0.43±0.6; P=0.59), (0.45±0.12, and 0.46±0.1; P=0.05), and (0.45±0.06, and 0.45±0.1; P=0.31). Conclusion: According to the results obtained from this study, coenzyme Q10 had no significant effect on improving the performance of echocardiographic parameters in patients with DMD. Trial registration: The trial is registered at the Iranian Clinical Trial Registry (IRCT.ir) with the IRCT identification number IRCT2015070223018N1. Funding: This research has been financially supported by the Research Council of Tehran University of Medical Sciences

The Effect of Oral Midazolam and Chloral Hydrate Before Echocardiography in Pediatric Patients: A Randomized Double-Blind Clinical Trial

This study aimed to compare the effects of oral midazolam and chloral hydrate in pre-echocardiography sedation of children. In this double-blind clinical trial, 68 children were randomly assigned to midazolam (0.2 mg/kg) or chloral hydrate (50 mg/kg). The intensity, duration, and onset of the drugs’ effects were assessed. Data were analyzed using the χ 2 and Mann-Whitney tests ( P ≤ .05). The average onset and duration of sedation in the children assigned to midazolam was shorter than in those assigned chloral hydrate (6.35 ± 3.65 and 19.14 ± 5.86 minutes, P = .0001, and 27.64 ± 8.34 and 48.97 ± 14.81 minutes, P = .0001). Gastrointestinal side effects were more frequent in the chloral hydrate group (23.5% against 0%, P = .003). According to the results of the present study, chloral hydrate and midazolam can be appropriate choices for pre-echocardiography sedation of patients without cardiovascular risk factors. Considering the similar effectiveness, more rapid onset, and shorter duration of sedation, besides less side effects in the midazolam group, researchers recommend the routine use of this drug