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Pilgrim JL, Jenkins EL, Baber Y, Caldicott D, Drummer OH. Fatal acute poisonings in Australian children (2003-13). Addiction 2017; 112:627-639. [PMID: 27766705 DOI: 10.1111/add.13669] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/21/2016] [Accepted: 10/19/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Fatal poisonings in children comprise a small proportion of cases investigated by an Australian coroner; however, they present a major opportunity for death prevention. This study aimed to examine fatal child poisonings in Australia to (1) estimate the rate of acute poisoning deaths in children; (2) describe the key characteristics of the cohort; and (3) describe the outcomes of coronial recommendations made as a death prevention measure. DESIGN Retrospective case series. SETTING The National Coronial Information System (NCIS), a database of cases reported to an Australian coroner. PARTICIPANTS Ninety poisoning deaths reported to an Australian coroner between January 2003 and December 2013 involving children (≤ 16 years of age). MEASURES Logistic regression, Pearson's correlation coefficient and descriptive statistics were used to examine the significance of associations. The primary outcome measures were poisoning type and cause of death. Covariates included age and mental illness. FINDINGS There were marginally more males (52.2%) [confidence interval (CI) = 44.4-45.6] in the cohort and most occurred in the 13-16-year age group (58.9%) (CI = 7.5-12.5). Deaths were typically unintentional (61.1%) (CI = 17.9-27.1) and occurred in the home (68.9%) (CI = 6.8-15.7). The most common form of poisoning was due to opioids (24.4%), followed by carbon monoxide (20%) and volatile substances (18.9%) (CI = 18.5-19.6). Males had slightly higher odds of dying from prescription opioids compared with females [odds ratio (OR) = 1.9, CI = 0.7-5.1], but this was not statistically significant. A recommendation was made by a coroner in 12 cases, 10 of which related to poisons (including drugs). Of these, eight recommendations were implemented. CONCLUSIONS In Australia between 2003 and 2013 there were on average eight acute poisoning deaths in children each year, most commonly involving prescription opioids and adolescents. There has been a downward trend in mortality since 2003. These cases generated more than twice as many recommendations for public safety compared with other Australian coroners' cases.
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Affiliation(s)
- Jennifer L Pilgrim
- Department of Forensic Medicine, Monash University, Australia.,Deaths from Emergencies and Accidents Data Set (DEADSet) Project, Australia
| | - Elizabeth L Jenkins
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia.,Deaths from Emergencies and Accidents Data Set (DEADSet) Project, Australia
| | - Yeliena Baber
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - David Caldicott
- Deaths from Emergencies and Accidents Data Set (DEADSet) Project, Australia.,Calvary Health Care, Australian National University, Australian Capital Territory, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Monash University, Australia.,Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
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Bhad R, Jain R, Dhawan A, Mehta M. A Clinic-Based Study in Treatment-Seeking Adolescent Inhalant Users in India: Implications for Management. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2016. [DOI: 10.1080/1067828x.2016.1222977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Roshan Bhad
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Raka Jain
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anju Dhawan
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Manju Mehta
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Abstract
OBJECTIVE Volatile organic compounds can be maintained easily and can cause dependency. Volatile substance abuse may cause damage by affecting several systems. The aim of our study was to evaluate renal functional damage in volatile substance abusers by diuretic renogram. METHODS Twenty nine volatile substance abusers and 30 young healthy voluntary young men were included in our study. Technetium-99m mertiatide diuretic renogram was used to evaluate renal functions and collective system urodynamics to investigate the progress of renal functional damage. Images were evaluated visually and quantitatively. Split renal function of each kidney, time to peak activity (Tmax), and half-time for radiopharmaceutical clearance from pelvicalyceal system (T1/2), ratio of cortical and whole-kidney counts at 20-3 min, and maximum counts (T20/3 and T20/max) were compared in the two groups. RESULTS In the study group, time to reach peak activity was statistically prolonged compared with the healthy volunteers. In the volatile substance abuser group, the average Tmax values, average T1/2 values, cortical and whole-kidney T20/3, and T20/max values were found to be prolonged compared with the control group in the diuretic renogram. There was no significant difference in the split renal function ratios between the two groups. CONCLUSION In this study, possible renal functional damage was evaluated in volatile substance abusers by diuretic renogram. In conclusion, diuretic renogram can be useful in the evaluation of renal functional damage before blood renal function tests are affected and it could be used in the follow-up of the disease in volatile substance abusers. The results of this pilot study from our country, of course, should be supported by further clinical studies.
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Vilar-López R, Takagi M, Lubman DI, Cotton SM, Bora E, Verdejo-García A, Yücel M. The effects of inhalant misuse on attentional networks. Dev Neuropsychol 2013; 38:126-36. [PMID: 23410215 DOI: 10.1080/87565641.2012.745547] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Inhalant misuse among adolescents is poorly understood from a neuropsychological perspective. This study aimed to identify attentional deficits related to inhalant misuse measured with the Attention Network Test (ANT). We examined three groups: 19 inhalant users, 19 cannabis users, and 18 community controls. There were no group differences on the ANT measures of orienting, alerting, and executive control. However, compared to the cannabis and control groups, inhalant users demonstrated an increased rate of response errors in the absence of any reaction time differences. These differences may reflect a selective deficit in sustained attention or greater impulsivity in the inhalant group.
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Affiliation(s)
- Raquel Vilar-López
- Melbourne Neuropsychiatric Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Abstract
BACKGROUND This study investigates the association between inhalant use and information processing (IP) in adjudicated polysubstance users. Polysubstance users who used inhalants (n= 158) were compared with polysubstance users who did not use inhalants (n= 303). Hispanic Americans comprised 72% of the participants; European Americans, African Americans and Asian Americans comprised 28% of the participants. METHOD Standardized intelligence and achievement tests were used to assess information-processing constructs of working memory and processing speed. Psychosocial and substance abuse standardized surveys were used to assess drug use severity and psychosocial problems associated with substance use. RESULTS Polysubstance users who used inhalants (PSI users) were younger, used more drugs more frequently and had more psychiatric admissions than non-inhalant polysubstance users (PSO users). Statistical analysis also shows that PSI users performed worse on measures of IP selected tests in comparison with the PSO users. CONCLUSION Inhalant users begin abusing substances at a younger age and suffer from more verbal and non-verbal processing, behavioural, language and memory problems than non-inhalant users.
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Affiliation(s)
- K D Scott
- Department of Counseling Psychology, University of Texas at San Antonio, UT Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284, USA
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Olgar S, Oktem F, Dindar A, Kilbas A, Turkoglu UD, Cetin H, Altuntas I, Yilmaz R, Uz E, Ertugrul T, Omeroglu R, Aydogan U. Volatile solvent abuse caused glomerulopathy and tubulopathy in street children. Hum Exp Toxicol 2008; 27:477-83. [DOI: 10.1177/0960327108092292] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Substance misuse among street children is a significant problem in developing countries. Volatile substances are the most abused agents. According to case reports, chronic renal diseases are common among substance-abusing street children. In this study, we examined the renal findings of 42 volatile substance–abusing street children and compared them with results from 49 healthy children (control). The street children’s weight, height, and blood pressure were lower than the controls’ ( P < 0.05). However, their blood alkaline phosphatase and creatinine phosphokinase levels were higher ( P < 0.05), and total blood protein, creatinine, and phosphorus levels were lower than the controls’ ( P < 0.05). Furthermore, the street children’s glomerular filtration rates were within normal limits ( P < 0.05), their urinary N-acetyl-beta-glucosaminidase (NAG), β2-microglobulin, microalbumin, protein, calcium, phosphorus, sodium, potassium, and chloride excretions were higher, and tubular phosphate reabsorption were lower than the controls’ ( P < 0.05). Volatile substances have been charged with causing distal tubular disease, but increased urinary protein, NAG, β2-microglobulin, microalbumin, and electrolyte excretions also result from glomerular, proximal, and distal tubular influences. We believe that increased volatile substance products in the renal parenchyma are responsible for glomerular and tubular damage. Volatile substance–abusing street children should be examined for glomerular and proximal tubular function and distal tubular acidosis.
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Affiliation(s)
- S Olgar
- Department of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine, Capa, 34390, Istanbul, Turkey
| | - F Oktem
- Department of Pediatric Nephrology, School of Medicine, Suleyman Demirel University, 32260 Isparta, Turkey
| | - A Dindar
- Department of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine, Capa, 34390, Istanbul, Turkey
| | - A Kilbas
- Department of Biochemistry, Suleyman Demirel University, Faculty of Medicine, Cunur, 32260 Isparta, Turkey
| | - UD Turkoglu
- Department of Biochemistry, Istanbul University, Istanbul Faculty of Medicine, Capa, 34390 Istanbul, Turkey
| | - H Cetin
- Department of Pediatric Nephrology, School of Medicine, Suleyman Demirel University, 32260 Isparta, Turkey
| | - I Altuntas
- Department of Biochemistry, Suleyman Demirel University, Faculty of Medicine, Cunur, 32260 Isparta, Turkey
| | - R Yilmaz
- Department of Medical Biology and Genetics, School of Medicine, Suleyman Demirel University, 32260 Isparta, Turkey
| | - E Uz
- Department of Medical Biology and Genetics, School of Medicine, Suleyman Demirel University, 32260 Isparta, Turkey
| | - T Ertugrul
- Department of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine, Capa, 34390, Istanbul, Turkey
| | - R Omeroglu
- Department of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine, Capa, 34390, Istanbul, Turkey
| | - U Aydogan
- Department of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine, Capa, 34390, Istanbul, Turkey
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Abstract
Substance abuse is prevalent in adolescent street children, and death is reported as secondary to aspiration, accidental trauma, asphyxia, cardiac arrhythmia, anoxia, vagal inhibition and respiratory depression. In this study, we examined electrocardiographic and echocardiographic findings from 53 street male adolescents, comparing our findings to those obtained from 61 controls in the same age group. The street children smoked cigarettes (98.1%) and had used, or were using, thinner (73.6%), glue (75.5%), hashish (79.2%), morphine or its products (24.5%), ecstasy (37.7%), anti-emetics (13.2%) and alcohol (60.4%). On examination, their blood pressures were lower than the control group. Electrocardiographically, PR, QRS, QT were found to be longer (p less than 0.05) than the values for healthy controls. Although it was not statistically significant, QTc duration was also longer than the control group. Echocardiography revealed increased diameters of the left ventricle and atrium, the aorta, and the coronary arteries as compared to the healthy children (p less than 0.05).
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