An epidemiological snapshot of toxicological exposure in children 12 years of age and younger in Riyadh.

BACKGROUND: Poisoning among the pediatric population is an important public health concern that is responsible for frequent pediatric emergency department visits and hospital admissions. Surveillance of poisoning cases is essential for designing and implementing effective preventive strategies. OBJECTIVE: Describe the characteristics of acute poison exposure and related therapeutic interventions in children aged 12 years and younger. DESIGN: Prospective, descriptive cross-sectional study. SETTING: Two pediatric emergency departments in Riyadh. PATIENTS AND METHODS: We prospectively reviewed pediatric poisonings that presented to emergency departments over a period of two years. MAIN OUTCOME MEASURES: Epidemiological aspects of pediatric poisoning Riyadh. SAMPLE SIZE: 1035 patients. RESULTS: The median (IQR) age at the time of exposure was 27 (23-42) months. The most frequently involved substance class was toxic household products in children younger than 6 years and pesticides in children 6 years or older. A frequently involved single agent was paracetamol in younger and older children. The majority of patients (78.7%) were completely asymptomatic at the time of presentation and during the observation period. Almost half of the exposure incidents (47.8%) needed no intervention. Most exposure incidents (95%) did not require any pharmacological support and most (87%) did not require nonpharmacological intervention. Eight (0.7%) patients required intubation and mechanical ventilation. Activated charcoal was administered for 27% of cases. Gastric lavage, whole bowel irrigation, and ipecac were used in a few cases (1%, 0.3%, and 0.1%, respectively). Enhanced elimination interventions were performed for only 0.5% of exposure cases. Only two patients died. CONCLUSIONS: Household products were the commonest reason for pediatric poisonings in Saudi Arabia and most of them were asymptomatic. Our results suggest a need for strategic plans for prevention and care. LIMITATIONS: May not be representative of the experiences and practices of smaller hospitals in remote regions of the country. CONFLICT OF INTEREST: None.

Coumarin incorporated triazoles: a new class of anticonvulsants.

A series of coumarin incorporated 1,2,4- triazole compounds (1-14) were evaluated for their possible anticonvulsant and neurotoxic properties, log P values, pharmacophoric mapping and three dimensional structure analysis. Compound (6) with para-fluoro substitution showed significant anticonvulsant activity.

Synthesis, characterization and in vivo anticonvulsant and neurotoxicity screening of Schiff bases of phthalimide.

A series of Schiff bases of phthalimide (4a-l) were prepared in satisfactory yields and evaluated for their anticonvulsant and neurotoxicity activities. The structures of all the compounds were in good agreement with elemental analysis and spectral data. All the compounds were active in MES screen and less neurotoxic than phenytoin. Compound 41 having nitro substitution at ortho position of the distal aryl ring emerged as most promising anticonvulsant agent with low neurotoxicity.

Novel, selective sample stacking microemulsion electrokinetic capillary chromatography induced by reverse migrating pseudostationary phase for the determination of the new ultra-short acting hypnotic "HIE-124" in mice serum.

Microemulsion electrokinetic capillary chromatography (MEEKC) with sample stacking induced by reverse migrating pseudostationary phase (SRMP) technique in a suppressed electro-osmotic flow (EOF) strategy was investigated for analysing the new ultra-short hypnotic HIE-124 in mice serum. The proposed method utilized fused-silica capillary with a total length of 50 cm (effective length 40 cm), applied voltages for stacking and separation were 5.0 kV for 4.30 min and subsequently 25 kV, respectively, with a sample injection of 0.5 psi for 90 s. All the runs were carried out at 25 degrees C and detected at 213 nm. The optimum microemulsion background electrolyte (BGE) solution consisted of 0.8% (v/v) ethyl acetate, 6.6% (v/v) butan-2-ol, 1.0% (v/v) acetonitrile, 2.0% (w/v) sodium dodecyl sulfate (SDS), and 89.6 mL with 25 mM phosphate buffer pH 8. When this preconcentration technique was used, the sample stacking and the separation processes took place successively with changing the voltage with an intermediate polarity switching step. The proposed method was validated carefully with respect to high specificity of the method, good linearity (r=0.9994), fair wide linear concentration range (66-1500 ng mL(-1)), limit of detection and quantitation were 21.6 and 65.5 ng mL(-1), respectively. The mean relative standard deviation (RSD) of the results of intra- and inter-day precision and accuracy were less than 6.0%, and overall recovery higher than 95% of HIE-124 in mice serum. The developed method could be used for the trace analyses of HIE-124 in serum and was finally used for the pharmacokinetic study investigation of HIE-124 in mice serum.

Rapid and sensitive simultaneous determination of ezetimibe and simvastatin from their combination drug products by monolithic silica high-performance liquid chromatographic column.

A simple, precise and rapid high-performance liquid chromatography (HPLC) method has been developed and validated for the simultaneous determination of ezetimibe (EZE) and simvastatin (SIM) from their combination drug products. The applicability of monolithic LC phases in the field of quantitative analysis has been evaluated. The existing method with UV detection set at 240 nm was successfully transferred from a conventional silica column to a 10 cm x 4.6 mm i.d. monolithic silica column. By simply increasing the mobile phase flow rate, run time was about five-fold reduced and the consumption of mobile phase was about two-fold decreased, while the chromatographic resolution of the analytes remain unaffected. Ranitidine (RAN) was used as internal standard to guarantee a high level of quantitative performance. The method used a mobile phase consisted of acetonitrile-ammonium acetate (50 mM pH 5.0) (65:35, v/v). It was validated with respect to system suitability, specificity, limit of quantitation (LOQ) and detection (LOD), linearity, precision, accuracy, and recovery, respectively. The described method was linear over the range of 40-1200 ng ml(-1) (r=0.999) for both drugs. The LOD for EZE and SIM were 13.2+/-0.4029 and 13.3+/-0.4772 ng ml(-1), respectively. The LOQ were found to be 39.9+/-1.221 and 39.5+/-1.446 ng ml(-1) for EZE and SIM, respectively. The method is fast (less than 2.0 min) and is suitable for high-throughput analysis of the drug and ones can analyze 700 samples per working day, facilitating the processing of large-number batch samples.

Robotic pyeloplasty: experience with three robotic platforms.

PURPOSE: Laparoscopic pyeloplasty is a technically challenging procedure. Currently, several robotic surgical systems exist to overcome laparoscopic technical challenges confronted during pyeloplasty. We present a clinical comparison between three robotic surgical systems (Aesop, Zeus and da Vinci) in assisting laparoscopic pyeloplasty procedures. METHODS: From January 2002 to August 2005, 32 dismembered laparoscopic pyeloplasties were performed using three robotic surgical systems. The results of the initial six, five and nine laparoscopic robotic pyeloplasty procedures performed using the Aesop, Zeus and da Vinci platforms were compared. Data relating to the subsequent 12 pyeloplasties using the da Vinci system were also analyzed. RESULTS: The da Vinci robot required significantly more time to set up initially than the Aesop platform (12.5 min versus 39 min, p < 0.05) but the time was similar to that for the Zeus robot. Despite the longer setup time, laparoscopic robotic pyeloplasties performed using the da Vinci robot required 168 min and 35 min for operating time and anastomotic time, respectively. This was significantly faster than that for Aesop (262 min and 75 min) and Zeus (225 min and 71 min) robots (p < 0.05). There were no intra-operative complications. There was only one postoperative complication in the Zeus group involving a delayed urine leak. Narcotic requirements were low and duration of hospital stay was short for all patients. CONCLUSIONS: We show that not all advanced robotic platforms are equal. In this study, procedures performed using the da Vinci robotic system resulted in decreased anastomotic and operating times. With emerging surgical technologies, the role of the robot in surgery continues to be defined.

Intraoperative laparoscopic renal ultrasonography: use in advanced laparoscopic renal surgery.

OBJECTIVES: To highlight the use of intraoperative laparoscopic ultrasonography (ILUS) in complex renal surgery, as well its impact on management. ILUS has been used to facilitate advanced laparoscopic surgery, but only limited descriptions of the indications for its use have been published. METHODS: All patients undergoing laparoscopic renal procedures requiring ILUS from October 2001 to March 2005 were reviewed. A total of 50 cases, including 35 partial nephrectomies, cryoablation of 6 renal tumors, 6 radical nephrectomies, 2 perinephric explorations, and 1 resection of a renal artery aneurysm were assessed by ILUS. RESULTS: The average tumor size in the patients undergoing laparoscopic partial nephrectomy was 3.1 cm (range 1.4 to 8.0), and all margins were negative. Also, a previously unidentified satellite lesion was found in 1 patient. ILUS was essential in assessing iceball formation during laparoscopic renal cryotherapy. ILUS also proved useful in defining the anatomy during laparoscopic perinephric exploration, assessing renal vein thrombi during laparoscopic nephrectomy, and evaluating renal perfusion during laparoscopic renal artery aneurysm repair. CONCLUSIONS: ILUS can be extremely useful in advanced laparoscopic renal surgery. In a number of situations, it is an essential surgical tool. With expanding indications for laparoscopic surgery, the indications for ILUS continue to grow.

Laparoscopic management of advanced renal cell carcinoma with level I renal vein thrombus.

OBJECTIVES: To present our series of laparoscopic radical nephrectomy in patients with level I tumor thrombus. The existence of renal vein tumor thrombus presents a technical challenge in securing hilar control during the resection of a renal mass. To our knowledge, this experience represents one of the largest series of laparoscopic nephrectomy for renal cell carcinoma associated with a macroscopic renal vein thrombus. METHODS: From April 2002 to June 2004, 12 patients (8 men and 4 women) were diagnosed with renal masses. In addition to computed tomography, cavography and magnetic resonance imaging were used to determine the levels of tumor thrombi preoperatively in those who had suspicious involvement of the renal vein on computed tomography. RESULTS: Laparoscopic nephrectomy was performed in a standard fashion. Hand-assisted laparoscopic nephrectomy was used in 6 cases involving large tumors with bulky hilar adenopathy. All renal veins were stapled using an endoscopic vascular stapler. Intraoperative laparoscopic ultrasonography was used to delineate the extent of the vein thrombus in 4 cases to enable proper stapler positioning. No intraoperative complications occurred, and 2 cases were electively converted to open nephrectomy. The postoperative narcotic requirements and hospitalization times were low. Pathologic examination of the tumor specimens demonstrated negative resection margins in all patients. CONCLUSIONS: In carefully selected patients, laparoscopic resection of renal masses with level I renal vein thrombi is feasible. Because of technical considerations that may be identified intraoperatively, early conversion to open nephrectomy should be anticipated. Long-term results regarding oncologic control continue to be assessed.

Laparoscopic robotic pyeloplasty using the Zeus Telesurgical System.

We present the initial clinical experience using a robot to perform a laparoscopic dismembered pyeloplasty at a Canadian centre. Five patients were confirmed to have ureteropelvic junction obstructions through nuclear renography, cross sectional imaging and intravenous pyelography. After performing a retrograde ureteropyelography and double J stent placement, laparoscopic dismembered pyeloplasty was performed by a single surgeon at a remote workstation using the ZeusTM Telepresence Surgery System (Intuitive Surgicala). The mean total operative time was 225+/-48 minutes, anastomotic time was 71+/-16 minutes, and the mean time required to set-up the robot was 30+/-17 minutes. The estimated blood loss was less than 100 ml in each case. A mean total of 22+/-10 mg of morphine sulfate equivalents were used for analgesia, and the patients were discharged home after a mean of 58+/-10 hrs. There were no robotic failures, and all evaluable patients are free of pain and demonstrable obstruction. One patient developed a delayed urine leak, which resolved with percutaneous drainage. The robot provides the ability to perform complicated operations with precision through elimination of tremor, scaling of motion, and through the use of 'wristed' instruments that enhance the freedom of movement normally limited by straight-shafted laparoscopic needle drivers. The development of robotic telesurgery is still in its infancy, and the significance of its role in urologic surgery continues to be evaluated.

Reappraisal of use of X-rays in childhood ankle and midfoot injuries.

OBJECTIVES: To determine whether the Ottawa ankle rules (OAR) can be applied in children and what the potential reduction in the use of X-ray studies might be. METHODS: Prospective, observational study of children attending emergency department with blunt ankle and midfoot injuries. X-ray studies were obtained after recording of the physical assessment. A single investigator who was blinded to the emergency physician's interpretations and to the radiologist's interpretations of the studies then applied the OAR to each patient. Sensitivity, specificity, and positive and negative predictive values of the OAR were calculated with 95% confidence intervals. RESULTS: The OAR were 100% sensitive (95% CI=81-100%) and 30% specific (95%CI=19-43%). Positive and negative predictive values were 28% (95%CI=17-41%) and 100% (95% CI=82-100%) respectively. The number of X-ray studies ordered would have been reduced by 24% if the OAR had been applied. CONCLUSIONS: The Ottawa ankle rules are very sensitive and can be applied in children, resulting in a reduction in the use of X-rays studies.