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Pediatric toxicology

Philipp J Houck, Ansgar M Brambrink, Jennifer Waspe, James D O'Leary, Riva Ko
In the section of "Developmental Neurotoxicity: An Update" of the Pediatric Anesthesia Neurodevelopmental Assessment (PANDA) symposium 2018 the speakers presented the current literature in translational and clinical research. Dr. Brambrink spoke about translational research in anesthetic neurotoxicity, beginning with discovery in the rodent model, then focusing on evidence from nonhuman primates. Dr. Waspe applied the methodology of Adverse Outcome Pathways from the field of toxicology to developmental neurotoxicity of anesthetics...
January 2019: Journal of Neurosurgical Anesthesiology
Nina Lazarevic, Adrian G Barnett, Peter D Sly, Luke D Knibbs
BACKGROUND: Prenatal exposures to endocrine-disrupting chemicals (EDCs) during critical developmental windows have been implicated in the etiologies of a wide array of adverse perinatal and pediatric outcomes. Epidemiological studies have concentrated on the health effects of individual chemicals, despite the understanding that EDCs act together via common mechanisms, that pregnant women are exposed to multiple EDCs simultaneously, and that substantial toxicological evidence of adverse developmental effects has been documented...
February 2019: Environmental Health Perspectives
Magali Gauthey, Maya Capua, Jeffrey Brent, Yaron Finkelstein
BACKGROUND: Poisoning is the leading cause of injury-related death in the USA. Poisoning with malicious or criminal intent is uncommon, and poorly characterized. OBJECTIVES: To explore substances, patients' demographics, clinical presentation, management and outcome in victims of malicious poisoning in the USA. METHODS: Using the 47 participating sites of the Toxicology Investigators Consortium (ToxIC) Registry, a North American research consortium, we conducted an observational study of a prospectively collected cohort...
January 14, 2019: Clinical Toxicology
Anita Anne Thomas, Tavis Dickerson-Young, Suzan Mazor
BACKGROUND: Recreational marijuana became commercially available in Washington State in 2014. Children with marijuana intoxication can have lethargy and altered mental status, often resulting in extensive workup. OBJECTIVES: The aim of this study was to quantify the incidence of pediatric marijuana exposure before and after marijuana legalization/commercial availability in Washington State at a tertiary care children's hospital. METHODS: Charts of patients 9 years or younger evaluated at a tertiary care pediatric hospital from October 8, 2007, to October 31, 2016, were retrospectively reviewed...
December 27, 2018: Pediatric Emergency Care
Rebecca Y Du, Melissa A LoPresti, Caroline C Hadley, Sandi Lam
PURPOSE: In lower-income populations, high rates of neural tube defects (NTDs) are a concern. Nutritional folate deficiencies and mycotoxins in contaminated food supplies increase risk of NTDs. As physicians in public health and involved in the care of children with NTDs, pediatric neurosurgeons have an interest in the treatment and prevention of NTDs. We aimed to evaluate the literature to assess the awareness and the existence of best practices/educational materials on this issue to better guide management...
December 14, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Michael Gottlieb, Kimbia Arno, Matthew Kuhns, Teresa M Chan
Introduction: There are over 200 emergency medicine (EM) residency programs in the United States. While there are basic criteria defined by the Accreditation Council for Graduate Medical Education (ACGME), there can be significant variation between programs with regard to rotation distribution. Therefore, it would be valuable to have a benchmark for programs to understand their rotation mix in the context of the national landscape. This study aimed to provide a breakdown of the length and percentage of EM residency programs with each clinical rotation in the United States...
October 2018: AEM Education and Training
Sriram Ramgopal, Sylvia Owusu-Ansah, Christian Martin-Gill
BACKGROUND: Pediatric patients attended to by emergency medical services (EMS) but not transported to the hospital are an at-risk population. We aimed to evaluate risk factors associated with nontransport by EMS in pediatric patients. METHODS: We reviewed medical records of 24 agencies in a regional EMS system in Southwestern Pennsylvania between January 1, 2014, and December 31, 2017. We abstracted demographics (age, sex, medical complaint, median household income by zip code, race, ethnicity), clinical characteristics (abnormal vital signs by age, procedures done), and transport characteristics...
October 29, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Darlen Cardoso de Carvalho, Alayde Vieira Wanderley, André Mauricio Ribeiro Dos Santos, Marianne Rodrigues Fernandes, Amanda de Nazaré Cohen Lima de Castro, Luciana Pereira Colares Leitão, João Augusto Nunes de Carvalho, Tatiane Piedade de Souza, André Salim Khayat, Sidney Emanuel Batista Dos Santos, Paulo Pimentel de Assumpção, Ney Pereira Carneiro Dos Santos
The treatment of Acute Lymphoblastic Leukemia (ALL) in children has a high clinical success rate, although toxicological complications are frequent, and often result in the interruption of the treatment. Various studies have shown that toxicities resulting from the treatment are influenced by pharmacogenetic variants. Most of this research has focused on relatively homogeneous populations, and the influence of these variants in highly admixed populations, such as that of Brazil, is still poorly understood. The present study investigated the association between pharmacogenetic variants and severe toxicities in pediatric B-cell ALL patients from an admixed population of the Brazilian Amazon...
September 15, 2018: Leukemia Research
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...
September 2018: Forensic Science International
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...
September 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
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
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
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
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
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
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...
September 2018: Therapeutic Innovation & Regulatory Science
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
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
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
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
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