Atropa belladonna (Deadly Nightshade) Poisoning in Childhood

ABSTRACT Objective: A very small amount of Atropa belladonna (AB) can lead to serious symptoms of poisoning and can cause death in children. In this study, demographic, clinic and laboratory results of AB poisoning were evaluated. Methods: A total of 108 cases with belladonna poisoning were retrospectively evaluated. At time of admission, age, age groups, gender, signs and symptoms caused by poisoning, duration of stay in hospital, laboratory data, intensive care needs, and applied treatments were recorded. Results: Approximately 44.4% were females and 55.6% were males. While the most common symptoms were xeroderma and flushing, the most frequent findings were tachycardia and mydriasis. Eight patients complained about astasis and five of them were taken into the intensive care unit. Astasis complaint was relatively higher (p < 0.01) in the patients who needed intensive care than those who did not. Creatine kinase levels were relatively higher (p = 0.06) in the intensive care patients as compared to non-intensive care patients. Neostigmine was given to all patients. Five patients, who failed to respond to therapy, were taken into the intensive care and respond to treatment successfully with physostigmine. Conclusion: Atropa belladonna poisoning may seriously progress in the act of late diagnosis and treatment in childhood. Thus, it is crucial to realize that AB poisoning should be taken into consideration in the patients with flushing, xeroderma with mydriasis, tachycardia, tremor, abdominal pain, and fever symptoms. Patients with astasis complaints should be evaluated carefully in terms of intensive care need. Patients with a Glasgow Coma Scale lower than 12 should be observed in the intensive care.

Ultrastructural evaluation of intramuscular applied botulinum toxin type A in striated muscles of rats.

BACKGROUND: Botulinum toxin type A (BTX-A) is clinically utilized for therapeutic and cosmetic purposes in maxillofacial surgery as well as many other medical specialties. There is no sufficient ultrastructural research about BTX and it is controversial whether BTX-A causes muscle degeneration to some extent, in the course of therapy. The aim of this study was to evaluate the histological effects of BTX-A when injected into masseter and gluteal muscles. MATERIALS AND METHODS: A total of 30 male Sprague-Dawley rats were used and randomly divided into experimental (n =15) and control groups (n =15). Masseter and gluteal muscles were injected with a single dose of BTX-A in normal saline (0.5 U/0.1 ml), or 0.1 ml of normal saline, in the experimental and control groups, respectively. After 12 weeks all the rats were sacrificed. Gluteal, masseter muscles, and the sciatic nerves of the rats were prepared and electron microscopic, and light microscopic evaluation was performed on semi-thin sections cut from Epon embedded tissues and stained with toluidine blue. Quantitative parameters such as muscle fiber thickness and qualitative assessments including sarcosomal (striated muscle mitochondria) deformation, glycogen content, features of the triad structures and the intensity of connective tissue around the muscle fibers, and endoneurial and perineural tissue around nerve fibers were evaluated microscopically. We paired BTX- A (+) and BTX-A (-) samples statistically. Independent Samples t-test was used for the statistical analysis. RESULTS: Muscle fiber's diameter was significantly decreased in BTX-A (+) group (p <0,001). Atrophic changes in the myofibrils were characterized by a decrease in the myofibrillar diameter and changes in the sarcomere structure, and were prominent in the BTX-A (+) group. Also, some other changes like dilatation in the sarcoplasmic reticulum cisternae, mitochondrial swelling, and clearing of mitochondrial cristae associated with degeneration, were detected. No morphologic difference in the sciatic nerve fibers was detected, and myelin sheaths of axon structures were intact in both groups. CONCLUSION: BTX-A-induced muscular changes that are predominantly related to atrophy instead of degeneration. Although predominantly related to atrophy, our degeneration related findings suggest that further studies are needed focusing on detecting BTX-A effects on a cellular level. Hippokratia 2016, 20(4): 292-298.

Comparison of snakebite cases in children and adults.

OBJECTIVE: There are very few studies that compare the snakebite cases in children and adults. The present study aimed to compare the demographic characteristics, clinical presentations, laboratory findings, and developed complications in pediatric and adult patients due to snakebites. PATIENTS AND METHODS: This study included the patients admitted to the hospital and monitored due to snakebite between July 1999 and December 2012. The condition of each patient who had been bitten was admitted to the hospital was monitored from the time of admission to the end of their hospital stay. The fact that a snakebite occurred was recorded if the subjects saw the snake or if the appearance of the puncture sites was convincingly a snakebite. RESULTS: The present work included 290 patients, of whom 123 were children and 167 were adults. The most common location of the bites was the lower extremity with 78.9% (n=97) and 63.5% (n=106) in pediatric and adult patients, respectively. All of the pediatric patients received prophylactic treatment with antibiotics, whereas 62 (37.1%) adult patients received antimicrobial treatments due to the soft tissue infection. The most common complication developed was pulmonary edema in children at a rate of 33.3% (n=41) and compartment syndrome in adult patients at a rate of 3% (n=5). CONCLUSIONS: Patients admitted to the hospital due to snakebite should be monitored for at least 12 hours, even if there is no sign of clinical envenomation. Antivenom treatment should be administered to the patients requiring clinical staging. Patients should be kept under close monitoring to prevent the development of serious complications such as cellulitis, pulmonary edema, compartment syndrome, and disseminated intravascular coagulation.

Evaluation of Device-associated Nosocomial Infections in a Paediatric Intensive Care Unit.

OBJECTIVE: The aim of this study was to evaluate the rate of device-associated healthcare-associated infections (DA-HAI) in a paediatric intensive care unit (PICU). In addition, the identities of the responsible micro-organisms and of their antibiotic sensitivities were determined. SUBJECTS AND METHODS: Patients who had been treated and followed-up in a PICU for more than 48 hours between January 2008 and December 2013 were included in the study. Device-associated nosocomial infections were defined by the Centers for Disease Control (CDC) criteria. RESULTS: Nosocomial infections were detected in 244 of the 7376 patients over the six-year period. A diagnosis of DA-HAI was made in 75 (30.7%) of these infections. The rates of device utilization were 26% for mechanical ventilators, 6% for central venous catheters and 0.9% for urethral catheters. The rate of device-associated infections was 30.7%, and their frequency was 1.9/1000 patient-days. The device-associated nosocomial infection rates for mechanic ventilators, central and urethral catheters were 5.6, 1.62 and 3.77 per 1000 patient-days, respectively. Of these infections, Pseudomonas aeruginosa was the most frequent pathogen. Patients who developed hospital infections had longer durations of ICU hospitalizations and more often had to use mechanical ventilators and central and urinary catheters. CONCLUSIONS: The duration of hospitalization and the use of mechanical ventilators and central and urinary catheters were related to the increases in nosocomial infections. Therefore, target-oriented active surveillance should be regularly performed, and the superfluous employment of invasive devices should be avoided.

Brucellosis as a trigger agent for Henoch-Schönlein purpura.

UNLABELLED: Vasculitis in childhood is a result of a spectrum of causes ranging from idiopathic conditions with primary vessel inflammation to syndromes after exposure to recognized antigenic triggers, such as infectious agents and drugs causing hypersensitivity reactions. Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood. Although there is often a history of a recent or simultaneous upper respiratory tract infection, no consistent causative organism is found. We report an 11-year old boy with HSP and brucellosis and we speculated that brucellosis was the trigger agent for HSP (Ref. 13). KEYWORDS: brucellosis, trigger agent, Henoch-Schönlein purpura, vasculitis, infectious agents, drug, hypersensitivity reactions, primary vessel inflammation.