Stimulant Toxicity in Children: A Retrospective Study on 147 Patients.

OBJECTIVE: To evaluate the signs/symptoms of different stimulant toxicities in children to determine differences among them. DESIGN: Observational, retrospective, single-center case-series. SETTING: The only referral hospital for pediatric poisoned patients in Tehran, Iran, covering 12.5 million permanent and 6.5 million temporary residents. PATIENTS: All children between 2007 and 2012 were evaluated. Their clinical findings, laboratory tests, electrocardiogram, and outcome were evaluated. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 147 patients were enrolled (115, 24, three, and five with methamphetamine, methylphenidate, ecstasy, and unknown stimulant toxicities, respectively). Median (interquartile range) age of the methamphetamine- intoxicated children (16 mo [22-42 mo]) was significantly less than those with methylphenidate toxicity (66 mo [33-105 mo]). Almost 79% of the patients had ingested the stimulant, whereas 9% had passively been exposed to the methamphetamine smoke. The frequency of stimulant toxicity had significantly increased during the 5-year period of the study. Restlessness, mydriasis, stereotypic movements, and talkativeness were the most common signs and symptoms. Whereas bruxism only seen in 66.7% (95% CI, 21-94%) of ecstasy users, the prevalence of restlessness, sweating, and tremor was also more in this group of children. On the other hand, mydriasis and stereotypic movements were more common in crystal-meth patients by 76.5% (95% CI, 68-83%) and 53% (95% CI, 44-62%), respectively. A comparison between different routes of crystal-meth intoxication showed that flushing was more common in those who had passively/actively smoked/inhaled methamphetamine (odds ratio, 6.3 [95% CI, 1.5-26]). Palpitation was more seen in methylphenidate toxicity by 12.5% (95% CI, 4-31%). Restlessness was more detected in toddlers, whereas talkativeness and ataxia were more common in older children. Nineteen children (21%) had prolonged QTc according to normal values in different ages. None of them died. CONCLUSIONS: More studies are warranted to evaluate the frequency and outcome of this poisoning in children. Educational preventive programs are also recommended.

Tramadol-induced apnea.

BACKGROUND AND OBJECTIVES: In contrast with other opioids, there are few cases of tramadol-related respiratory depression described in the literature, and renal impairment is a proposed risk factor. The aim of this study is to determine the prevalence of and predisposing factors for tramadol-related apnea in patients referred to our center. PATIENTS AND METHODS: All patients referred to Loghman-Hakim Hospital between February 2009 and April 2010 with pure tramadol intoxication were identified retrospectively. Data collected included the patient's age, sex, ingested dose, route of exposure, reason for poisoning (acute overdose or supratherapeutic use), previous history of suicidal attempts, previous history of drug or substance abuse (including tramadol), and clinical features on admission including seizures and apnea. RESULTS: We identified 525 patients with deliberate self-poisoning (359; 68.4%) or abuse (146; 27.8%), and in 114 (21.7%) of these, there was a history of tramadol abuse. Four hundred twenty-nine (81.7%) of patients had acute poisoning and were referred to hospital within 6 hours of ingestion. Nineteen patients (3.6%) experienced apnea and received respiratory support (16; 84.2%) or naloxone administration (3; 15.8%) within 24 hours of ingestion (mean, 7.7 ± 7 hours; range, 1-24 hours). The mean dose ingested by patients experiencing apnea was 2125 ± 1360 mg (range, 200-4600 mg), which was significantly higher than those who did not experience apnea, 1383 ± 1088 mg (range, 100-6000 mg), P < .001. One death occurred in each group, which was significant (P < .001). Renal impairment was not observed in any of the patients who experienced apnea.

Postcards in Persia: randomised controlled trial to reduce suicidal behaviours 12 months after hospital-treated self-poisoning.

BACKGROUND: Hospital-treated self-poisoning is common, with limited effective interventions for reducing subsequent suicidal behaviour. AIMS: To test the efficacy of a postcard intervention to reduce suicidal behaviour. METHOD: Randomised controlled trial of individuals who self-poisoned (n = 2300), the intervention consisted of nine postcards sent over 12 months versus usual treatment. Outcomes assessed at 12 months (n = 2113) were suicidal ideation, suicide attempts and self-cutting (proportion and event rates). RESULTS: There was a significant reduction in any suicidal ideation (relative risk reduction (RRR) = 0.31, 95% CI 0.22-0.38), any suicide attempt (RRR = 0.42, 95% CI 0.11-0.63) and number of attempts (incidence rate ratios (IRR) = 0.64, 95% CI 0.42-0.97). There was no significant reduction in any self-cutting (RRR = 0.14, 95% CI -0.29 to 0.42) or self-cutting events (IRR = 1.03 95% CI 0.76-1.39). CONCLUSIONS: A postcard intervention reduced suicidal ideation and suicide attempts in a non-Western population. Sustained, brief contact by mail may reduce suicidal ideation and suicide attempts in individuals who self-poison.

Factors associated with nonbenzodiazepine antiepileptic drug intoxication: analysis of 9,809 registered cases of drug poisoning.

PURPOSE: Antiepileptic drug (AED) intoxications are common due in part to wide clinical application and availability. Because AEDs usually depress central nervous system function, overdosing may be potentially life-threatening or lead to a range of adverse outcomes. The aim of this study was to identify risk factors for nonbenzodiazepine AED (NBAED) intoxication. METHODS: In this cross-sectional study, all consecutive adult and adolescent (>12 years old) poisoned patients who presented to the Loghman-Hakim Poison Hospital (LHPH) during a 6-month period were evaluated. Patients with NBAED intoxication were identified and compared to a control group of those other pharmaceutical intoxications. The risk factors for AED intoxication were identified using univariate analyses and multivariate modeling. RESULTS: Among 9,809 cases of pharmaceutical agent overdose, there were 474 cases (4.8%) with NBAED intoxication. Mean age of the subjects was 24.5 +/- 8.9 years. The most frequent NBAED was carbamazepine (n = 117), followed by phenobarbital (n = 77) and sodium valproate (n = 51). The most frequent motivation was intentional intoxication (95.3%). Multivariate analysis revealed that presence of medical disorders, a history of psychological events, and loneliness were associated with AED intoxication, whereas educational level had a protective effect. There was no association between previous history of parasuicide, sex, age, occupation status, and AED intoxication. DISCUSSION: In conclusion, this study showed that the majority of AED intoxications are due to deliberate self poisoning. The presence of psychological events, medical disorders, and loneliness are risk factors for AED intoxication, whereas higher education level has a protective effect.

Postcards in Persia: A Twelve to Twenty-four Month Follow-up of a Randomized Controlled Trial for Hospital-Treated Deliberate Self-Poisoning.

This study reports the outcomes, during follow-up, of a low-cost postcard intervention in a Randomized Control Trial of hospital-treated self-poisoning (n = 2300). The intervention was 9 postcards over 12 months (plus usual treatment) versus usual treatment. Three binary endpoints at 12-24 months (n = 2001) were: any suicidal ideation, suicide attempt, or self-cutting. There was a significant reduction in any suicidal ideation (RRR 0.20 CI 95% 0.13-0.27), (NNT 8, 6-13), and any suicide attempt (RRR 0.31, 0.06-0.50), (NNT 35, 19-195), in this non-western population. However, there was no effect on self-cutting (RRR -0.01, -1.05-0.51). Sustained, brief contact by mail may reduce some forms of suicidal behavior in self-poisoning patients during the post intervention phase.

Violence and Abuse Against Women Who Have Attempted Suicide by Deliberate Self-Poisoning: A 2-Year Follow-Up Study in Iran.

Sources of data about the occurrence of domestic violence are scarce in Iran. The aim of this study was to evaluate the behavioral effects of different types of domestic violence on women who had attempted suicide by deliberate self-poisoning (DSP). A total of 195 women who had attempted suicide by DSP in response to "violence and abuse" were followed up for 2 years. The most common type of violence, as mentioned by the women themselves as the motive of self-poisoning, was physical abuse (92%) followed by verbal abuse (2.1%), multi-abuses (2.1%), emotional abuse (1.6%), and sexual abuse (1.1%). Suicidal ideation and attempt were more common in those who were consulted sometime after they had initially presented to the hospital with DSP or those who had suffered repeated domestic abuse. It was concluded that invention of methods other than the current consultation system is necessary to prevent repeated suicide attempts among abused women in Iran.

Acute adult and adolescent poisoning in Tehran, Iran; the epidemiologic trend between 2006 and 2011.

BACKGROUND: The aim of this study was to determine the frequency of each poisoning and its related death in our center as a sample of Tehran in six consecutive years (2006 to 2011). METHODS: All poisoned children and adults referring to Loghman-Hakim hospital poison center and hospitalized in the study period were enrolled and evaluated. RESULTS: In 108,265 patients, the most common causes of poisoning were anti-epileptics and sedative-hypnotics (22.3%). The most common causes of death were pesticides (24.84%) and narcotics (24.75%). In drugs of abuse, opium was more prevalent in the early period of the study but was replaced by methadone later. CONCLUSION: It seems that national policies for drug control and prevention of suicide have not been efficient enough. We expect to see Iran in the first 50 countries with regard to suicide and to maintain the first place in narcotic abuse if enough attention is not provided.