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Pediatric toxicology

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https://www.readbyqxmd.com/read/30017664/intentional-heroin-administration-resulting-in-homicide-in-a-10-month-old-infant
#1
Anthea B Mahesan Paul, Lary Simms, Althea M Mahesan
Homicide occurs in approximately one in five injury-related deaths among infants in the United States and studies suggest that male caretakers (fathers or mothers' intimate partners) are the perpetrators of the majority of infant homicides. Opioid abuse is common and it is estimated that between 26.4 million and 36 million people abuse opioids worldwide. In this case report, we add to the literature the first reported homicide by intentional heroin administration in a 10-month old infant. Toxicology revealed morphine 1092ng/L, codeine 74ng/mL, and 6-monoacetyl-morphine 359ng/L in cardiac blood...
July 3, 2018: Forensic Science International
https://www.readbyqxmd.com/read/29845507/telemedicine-delivery-and-successful-reimbursement-in-toxicology
#2
Peter W Crane, Timothy J Wiegand, Michael Kamali, Marilynn Reif, Rose Wratni, Ronald Montante, Tracey Loveland
INTRODUCTION: Telemedicine and its use in medical toxicology have existed for some time. There are varied definitions, but existing ones center on using currently available forms of audio, video, and internet communications to provide "real-time" patient care. Definitions have historically limited reimbursement but recently expanded CMS guidelines have improved this. Here we describe our experience with telemedicine and reimbursement. METHODS: A retrospective study was conducted of all toxicology and billing reimbursement for fiscal year 2016 for a solo Medical Toxicology service...
May 29, 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/29796143/assessment-of-toxicology-knowledge-in-the-fourth-year-medical-students-three-years-of-data
#3
Jennie Buchanan, Daniel Windels, Jeffrey Druck, Kennon Heard
BACKGROUND: Pharmacology and toxicology are core content knowledge for physicians. Medical students should demonstrate understanding of general pharmacology and basic treatment of poisoning. The objective of this study was to measure the knowledge of the 4th-year medical students (MS4) on these topics over 3 years. METHODS: A multiple-choice exam (15 questions) was administered to MS4 students in spring of 2010, 2011, and 2012. Questions were developed by medical toxicologists to evaluate basic knowledge in three areas: pharmacologic effects (PE), treatment of poisoning (TOP), and pharmacokinetics (PK)...
2018: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29773498/special-considerations-for-the-use-of-pathogen-reduced-blood-components-in-pediatric-patients-an-overview
#4
REVIEW
Raymond P Goodrich, Jerard Segatchian
Pediatric patients requiring transfusion constitute one of the most challenging areas of transfusion practice. Due to the limitations posed by their particular physiological conditions they routinely require specialized component support and more personalised transfusion care than what is routinely utilized in the care of adult patients. Pediatric patients, unlike many adult patients requiring transfusion support, also generally have significant lifespans post-transfusion. This combined with the possibility of long term consequences to adverse events related to transfusion such as infection or change in immunological status drives the need to continue to use improved blood components in the transfusion support of pediatric patients...
June 2018: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/29766143/when-should-screening-of-pediatric-trauma-patients-for-adult-behaviors-start
#5
Adrian A Maung, Robert D Becher, Kevin M Schuster, Kimberly A Davis
Background: Care of patients with trauma is not only limited to the sustained physical injuries but also requires addressing social issues, such as substance abuse and interpersonal violence, which are responsible for trauma-related recidivism. This study investigates whether there are age-related variations in these problematic social behaviors to analyze whether there is an age cut-off at which point adolescents should be screened for adult social behaviors. Methods: Retrospective review of patients with trauma aged 12-21 admitted to an urban Level 1 adult and pediatric trauma center between February 2013 and April 2016...
2018: Trauma surgery & acute care open
https://www.readbyqxmd.com/read/29760852/altered-mental-status-current-evidence-based-recommendations-for-prehospital-care
#6
REVIEW
Ashley Sanello, Marianne Gausche-Hill, William Mulkerin, Karl A Sporer, John F Brown, Kristi L Koenig, Eric M Rudnick, Angelo A Salvucci, Gregory H Gilbert
Introduction: In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29759800/-hypertensive-crisis-and-anticholinergic-toxidrome-secondary-to-accidental-consumption-of-datura-stramonium-in-two-children
#7
D D Batouche, N-F Benatta, K Tabeliouna, S Boudjahfa, Y Touhami, S Hakkoum
OBJECTIVE: To identify a hypertensive clinical form of atropine or anticholinergic toxidrome secondary to accidental consumption of Datura seeds. PATIENTS AND METHODS: We report two cases of Datura intoxication in two children who presented marked anticholinergic syndrome whose diagnosis was made by the anamnesis and the clinic. RESULT: Patient 1: A 5-year-old boy, returns home agitated with balance disorders. He was admitted to pediatric resuscitation unit...
June 2018: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29714556/juvenile-animal-testing-assessing-need-and-use-in-the-drug-product-label
#8
Paul Baldrick
BACKGROUND: Juvenile animal testing has become an established part of drug development to support safe clinical use in the human pediatric population and for eventual drug product label use. METHODS AND RESULTS: A review of European Paediatric Investigation Plan decisions showed that from 2007 to mid-2017, 229 drugs had juvenile animal work requested, almost exclusively incorporating general toxicology study designs, in rat (57.5%), dog (8%), mouse (4.5%), monkey (4%), pig (2%), sheep (1%), rabbit (1%), hamster (0...
January 1, 2018: Therapeutic Innovation & Regulatory Science
https://www.readbyqxmd.com/read/29697655/-about-the-safety-of-application-of-nasal-decongestants-in-the-practice-of-pediatricians
#9
E P Karpova, D A Tulupov, M P Vorob'eva, F A Fedotov, D M Dolginov, M V Bykov, V A Grabovskaya
Undesirable effects of the application of the intransal vasoconstricting medications are a frequent occurrence in the pediatric practice. The objective of the present study was to evaluate the role of the intranasal vasoconstricting medications in the structure of the means and methods currently available for the treatment of toxicological pathologies based at a multi-field clinical hospital. The retrospective analysis of the medical histories of the patients admitted to the toxicological department and annual reports for the period from 2015 to 2016 was undertaken...
2018: Vestnik Otorinolaringologii
https://www.readbyqxmd.com/read/29615962/acute-hemichorea-can-be-the-only-clinical-manifestation-of-post-varicella-vasculopathy-two-pediatric-clinical-cases
#10
Chiara Davico, Carlotta Canavese, Aba Tocchet, Chiara Brusa, Benedetto Vitiello
Acute hemichorea can occur in the context of infectious, autoimmune, metabolic, toxic, and vascular neuropathologies. Primary infection by varicella zoster virus (VZV) can result in vasculopathy with neurological manifestations, such as hemiparesis, at times accompanied by hemichorea. Isolated hemichorea, however, had not been reported. We here describe two cases of VZV-induced vasculopathy whose sole clinical manifestation was acute hemichorea. Both cases involved young boys of 3 years of age, who presented with acute hemichorea 4-6 months after initial VZV infection...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29464595/toxicological-study-of-the-degradation-products-of-antineoplastic-agent-etoposide-in-commercial-formulation-treated-by-heterogeneous-photocatalysis-using-srsno-3
#11
Idio Alves de Sousa Filho, Tatiane Martins Lobo, Cesar Koppe Grisolia, Ingrid Távora Weber, Marly Eiko Osugi
Etoposide is an antineoplastic agent used for treating lung cancer, testicular cancer, breast cancer, pediatric cancers, and lymphomas. It is a pollutant due to its mutagenic and carcinogenic potential. Disposal of waste from this drug is still insufficiently safe, and there is no appropriate waste treatment. Therefore, it is important to use advanced oxidative processes (AOPs) for the treatment and disposal of medicines like this. The use of strontium stannate (SrSnO3 ) as a catalyst in heterogeneous photocatalysis reactions has emerged as an alternative for the removal of organic pollutants...
February 20, 2018: Environmental Science and Pollution Research International
https://www.readbyqxmd.com/read/29428413/treating-neonatal-abstinence-syndrome-in-a-rural-hospital-lessons-learned
#12
Anne Gadomski, Moira Riley, Katherine Ramiza, Lauren Onofrey, Ruth Zinkievich, Nicole Krupa, Melissa Scribani
OBJECTIVE: Our level 1 nursery and pediatric unit in a rural hospital adopted a family-centered, symptom-based oral morphine weaning protocol for neonatal abstinence syndrome (NAS) in 2009. Length of stay (LOS), treatment duration (TD), and hospital charges for infants treated for NAS were then compared to published data in neonatal intensive care units (NICUs) nationwide. METHODS: The electronic medical records of infants born January 1, 2011, to April 1, 2017, whose discharge diagnosis included an ICD-9 or ICD-10 code for NAS or prenatal drug exposure were paired with maternal electronic medical record and reviewed...
May 2018: Academic Pediatrics
https://www.readbyqxmd.com/read/29406477/intoxication-from-accidental-marijuana-ingestion-in-pediatric-patients-what-may-lie-ahead
#13
Osei Boadu, Grace Y Gombolay, Verne S Caviness, Chadi M El Saleeby
Marijuana is the most commonly used illicit drug. In young children, there are relatively few reports in the literature of acute marijuana intoxication. Here, we describe the case of a previously healthy 2-year-old girl who presented with clinical seizures. A urine toxicology screen showed elevated levels of tetrahydrocannabinol. The source of the drug was not identified. After a short stay in the hospital, the patient fully recovered with only supportive measures. In this report, we also summarize all domestic and international cases of marijuana intoxication in children younger than 6 years, in conjunction with the number of exposures in children of similar age identified by the US National Poison Data System...
February 5, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29395692/approach-to-the-agitated-emergency-department-patient
#14
Michael Gottlieb, Brit Long, Alex Koyfman
BACKGROUND: Acute agitation is a common occurrence in the emergency department (ED) that requires rapid assessment and management. OBJECTIVE: This review provides an evidence-based summary of the current ED evaluation and management of acute agitation. DISCUSSION: Acute agitation is an increasingly common presentation to the ED and has a broad differential diagnosis including metabolic, neurologic, infectious, toxicologic, and psychiatric etiologies...
April 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29301012/diagnosis-of-heroin-overdose-in-an-8-year-old-boy-reliable-contribution-of-toxicological-investigations
#15
M Soichot, S Julliand, J Filatriau, A Hurbain, E Bourgogne, A Mihoubi, H Gourlain, B Delhotal-Landes
Toxicological investigations are often required by clinicians in comatose patients with suspected poisoning. However, the usefulness of toxicological analyses to support a diagnosis of acute poisoning is debated among clinicians and the interpretation of laboratory tests is challenging given the wide diversity of analytical techniques available. We report the case of an 8-year-old boy who was admitted to an intensive care unit with severe respiratory depression and neurological impairment. In order to formulate appropriate hypothesizes about the diagnosis and circumstances of intoxication, clinicians consulted toxicologists for a comprehensive toxicological screening...
May 1, 2018: Journal of Analytical Toxicology
https://www.readbyqxmd.com/read/29232618/pediatric-medicolegal-autopsy-in-france-a-forensic-histopathological-approach
#16
Clémence Delteil, Lucile Tuchtan, Julia Torrents, Caroline Capuani, Marie-Dominique Piercecchi-Marti
The aim of postmortem medicolegal examination in pediatric death is primarily to establish the circumstances and causes of death and to exclude child abuse. In France, pediatric death is systematically documented by medicolegal or medical autopsy. In case of medicolegal autopsy, the complementary examinations, requested and financed by justice, are rarely limited to a histopathological examination. However in medical autopsies other tools are available to the pathologist as toxicology, biochemistry and molecular biology...
January 2018: Journal of Forensic and Legal Medicine
https://www.readbyqxmd.com/read/29227522/pediatric-pharmaceutical-ingestions
#17
REVIEW
Jennifer A Lowry, Michele Burns, Diane P Calello
Pharmaceutical ingestions comprise an important part of pediatric toxicology. Based on the 2015 Annual Report of the American Association of Poison Control Centers' National Poison Data System, coupled with recent epidemiology articles on the topic of pediatric toxicology, it is apparent that poison prevention education has not been completely successful in decreasing exposures to toxic drugs. From the unintentional ingestion in a toddler due to unsafe storage to the intentional adolescent ingestion for misuse and abuse, pharmaceutical medications continue to cause harm...
December 1, 2017: Pediatric Annals
https://www.readbyqxmd.com/read/29227520/pediatric-toxicology-household-product-ingestions
#18
REVIEW
Katherine A O'Donnell
Nonpharmaceutical household products are the most common substances involved in exploratory ingestions in young children. Fortunately, most of these products are not toxic if ingested in small volumes. However, there are several household products that have the potential to cause significant toxicity and, rarely, fatalities in young children. Key products reviewed in this article include alcohols, button batteries, corrosive cleaning products, laundry detergent pods, hydrocarbons, and magnets. [Pediatr Ann...
December 1, 2017: Pediatric Annals
https://www.readbyqxmd.com/read/29094827/-recommendations-for-stocking-and-using-antidotes-in-hospitals-of-varying-levels-of-complexity
#19
Raquel Aguilar-Salmerón, Lídia Martínez-Sánchez, Antoni Broto-Sumalla, Edurne Fernández de Gamarra-Martínez, Milagros García-Pelaéz, Santiago Nogué-Xarau
The stocking of antidotes in various care settings is a subject of debate. A group of experts in hospital pharmacy and both adult and pediatric clinical toxicology was formed to review the Spanish and international literature on the subject with the aim of updating recommendations about which antidotes to stock and in what amounts in hospitals of different levels of complexity. The experts also considered the usual indications for the use of antidotes and dosing. The amount to have on hand was defined as enough to treat an adult weighing 70 kg for 24 hours (or 3 such adults in an A-level hospital; ie, a highly complex center or the reference hospital for an area)...
February 2016: Emergencias: Revista de la Sociedad Española de Medicina de Emergencias
https://www.readbyqxmd.com/read/29016517/pediatric-poisonings-in-a-rural-ugandan-emergency-department
#20
Katherine L Boyle, Usha Periyanayagam, Kavita M Babu, Brian T Rice, Mark Bisanzo
OBJECTIVE: This study aims to describe pediatric poisonings presenting to a rural Ugandan emergency department (ED), identifying demographic factors and causative agents. METHODS: This retrospective study was conducted in the ED of a rural hospital in the Rukungiri District of Uganda. A prospectively collected quality assurance database of ED visits was queried for poisonings in patients under the age of 5 who were admitted to the hospital. Cases were included if the chief complaint or final diagnosis included anything referable to poisoning, ingestion, or intoxication, or if a toxicologic antidote was administered...
October 9, 2017: Pediatric Emergency Care
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