Periodic fever: a review on clinical, management and guideline for Iranian patients - part II

Periodic fever syndromes are a group of diseases characterized by episodes of fever with healthy intervals between febrile episodes. In the first part of this paper, we presented a guideline for approaching patients with periodic fever and reviewed two common disorders with periodic fever in Iranian patients including familial Mediterranean fever [FMF] and periodic fever syndromes except for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis [PFAPA]. In this part, we review other autoinflammatory disorders including hyper IgD, tumor necrosis factor receptor-associated periodic syndrome [TRAPS], cryopyrin associated periodic syndromes, autoinflammatory bone disorders and some other rare autoinflammatory disorders such as Sweet's and Blau syndromes. In cryopyrin associated periodic syndromes group, we discussed chronic infantile neurologic cutaneous and articular [CINCA] syndrome, Muckle-Wells syndrome and familial cold autoinflammatory syndrome. Autoinflammatory bone disorders are categorized to monogenic disorders such as pyogenic arthritis, pyoderma ;gangraenosum and acne [PAPA] syndrome, the deficiency of interleukine-1 receptor antagonist [DIRA] and Majeed syndrome and polygenic background or sporadic group such as chronic recurrent multifocal osteomyelitis [CRMO] or synovitis, acne, pustulosis, hyperostosis and osteitis [SAPHO] syndrome are classified in sporadic group. Other autoinflammatory syndromes are rare causes of periodic fever in Iranian system registry

Suicide epidemiology and characteristics among young iranians at poison ward, Loghman-Hakim Hospital [1997-2007]

Suicide is a critical public health problem. In developing countries, the highest suicide rate is found in young adults with remarkable increasing rate. In this study, we have evaluated the epidemiology and characteristics of 8-16-year-old individuals who attempted suicide and were hospitalized in Loghman-Hakim Hospital, Tehran, Iran from 1997 to 2007. A total of 6414 hospitalized patients, ages 8-16, who attempted suicide and were residents of Loghman-Hakim Hospital were investigated. We performed a retrospective chart review to study the characteristics of cases in a 10-year period by review of psychiatric and medical records. Out of 6414 patients 22.6% were male, 5978 patients were 12-16 years old and the rest were aged 8-12 years. During the 10-year period, suicides showed a rising trend among adults, while in children no significant increase was detected. Communicative disorders were the most common underlying risk factors, particularly in females. One patient out of five cases had psychiatric disorders, of which adjustment disorders were the most predominant. A remarkable peak in suicides was observed in May and July, while winter had the highest suicide rate among seasons. Suicide due to drug overdose is higher in females than males in young population. This increasing trend is a psychiatric concern and should be resolved by improving mental and public health

[Methadone poisoning among children referred to Loghman-Hakim Hospital in 2009]

Opioid poisoning is one of the most dangerous and common poisoning in Iranian children. According to changing in the pattern of opium abuse in adult and dramatically increasing of methadone poisoning in recent years, this new study was conducted in children referred to Loghman-Hakim Hospital in 6 months in 2009. In this descriptive study, clinical symptoms, laboratory findings and treatment protocol of 31 methadone poisoned child were studied. Patients were 16 [51.6%] boys and 15 [48.4%] girls with a mean age of 55 months [ages ranging from 4 months to 12 years]. Methadone was fed to them accidentally. Onset of symptoms of poisoning was 1.53 hours after taking the methadone that represented the long period between ingestion and symptoms. Clinical manifestations were: lethargy [75%], miosis [68%], vomiting [61%], respiratory depression [57%] and apnea [40%].The most common laboratory finding was respiratory acidosis [69%] followed by leukocytosis [55.2%], hyponatremia [17%] and long QT interval [23.8%]. The duration of naloxone infusion was 51 hours and in 3 patients the symptoms reappeared after discontinuation of naloxone drip and this time was higher in apnostic patient [p<0.001]. Aspiration pneumonia was occurred in 17% of apnostic patient [p<0.022]. More than half of patients referred to hospital without any effective treatment. Opioid intoxication including opium and methadone poisoning are severe and life-threatening in children. Long treatment with naloxone and reappearing of symptoms after discontinuation of naloxone in this poisoning should be considered