Paracetamol overdose in Danish children and adolescents during the Covid-19 restrictions

INTRODUCTION

To assess the effect of long-term isolation on the mental state of Danish youth. This study aimed to investigate trends in paracetamol overdoses among people under 18 years of age in Denmark during Covid-19 restrictions as an indicator of mental health.

METHODS

All patients under the age of 18 years presenting with paracetamol overdose at one of the 18 paediatric departments in Denmark from 2016 to 2021 were included. They were identified in all Danish hospital databases using specific diagnostic codes.

RESULTS

From 2016 to 2021, a total of 3,217 people under 18 years of age were admitted for paracetamol overdose. Among these, 86% (n = 2,755) were girls and 14% (n = 462) were boys. During 2020, a slight (7%) decrease in admissions was observed among both boys and girls compared with the preceding four-year mean value. In 2021, the number of overdoses among girls exceeded by 35% the former all-time high from 2016. Furthermore, the number of overdoses among girls exceeded the pre-four-year period mean value by 43%. Among boys, an 8% increase was seen from the highest ever previous value recorded in 2019 and a 23% increase compared with the previous four-year mean value.

CONCLUSIONS

During the first year of restrictions, a slight decrease in paracetamol overdoses was observed, possibly associated with limited accessibility. The second year showed a considerable increase in paracetamol overdoses, which may imply an affected mental state among youth during the prolonged lockdown restrictions as seen in previous epidemics. Therefore, further studies are warranted to develop a pandemic preparedness plan to protect general mental health.

FUNDING

None.

TRIAL REGISTRATION

Not relevant.

Danish children with ZZ-homozygous alpha-1 antitrypsin deficiency are more affected on liver parameters than children with heterozygosity

AIM

The longitudinal health status of Danish children with alpha-1 antitrypsin deficiency had never previously been characterised. This study aimed to assess the changes in growth, lung and liver function through childhood in these children.

METHODS

Danish children diagnosed between 2005 and 2020 with pathogenic variants in the Serpin family A member 1 gene were included. Retrospective data on growth, lung and liver parameters were obtained from local databases. Anthropometric Z-scores and composite liver scores were computed. Growth and blood results were analysed using robust linear mixed models.

RESULTS

The study included 184 children (68 with ZZ-homozygosity, 116 with heterozygosity). The median follow-up time was 7 years [IQR 3.75-9.00] for children with ZZ-homozygosity and 0.5 years [IQR 0.0-2.0] for children with heterozygosity. Both groups had low weight-for-height Z-scores at diagnosis but experienced catch-up growth during the first year of life. In addition, children with ZZ-homozygosity had higher serum concentrations of γ-glutamyl transferase and alanine aminotransferase throughout childhood, when compared with children with heterozygosity. Data proved insufficient to assess lung function properly.

CONCLUSION

Children with ZZ-homozygosity were more affected on serum liver parameters throughout childhood when compared with children with heterozygosity. Both groups experienced catch-up growth during the first year of life.

Screening for neonatal hyperbilirubinaemia and ABO alloimmunization at the time of testing for phenylketonuria and congenital hypothyreosis

In a population-based study including 2463 infants, serum bilirubin measurements were added to the neonatal screening programme for phenylketonuria and congenital hypothyreosis. This screening programme detected 11/17 (65%) of infants with serum bilirubin levels >350 micromol 1(-1), of whom 7 (3 per 1000) were readmitted from home (6 treated with phototherapy). A total of 139 infants (5.6%) received phototherapy. Maternal blood type O occurred significantly more often in term infants treated (30/54; 55.6%) compared with preterm infants treated (32/85; 37.6%) and with blood type O occurrence in the total population of mothers (906/2426; 37.3%) (p < 0.05). The blood type constellations mother O/infant A or B showed a sensitivity of 64%, specificity 65%, positive predictive value 12% and a negative predictive value of 96% for the requirement of phototherapy for the whole material. Exchange transfusion was not required in any of the infants. No infant developed bilirubin encephalopathy (kemicterus). Adding bilirubin to a neonatal screening programme detects some cases with unexpectedly high bilirubin levels in need of intervention. Routine ABO blood typing of pregnant women, ABO cord blood typing and Coombs' test in infants of mothers with blood type O cannot be recommended because of low positive predictive value for the requirement of intervention (phototherapy) by these tests.

Development and validation of a size exclusion chromatography method for determination of molecular masses and molecular mass distribution in low molecular weight heparin

A precise and rugged high performance size exclusion chromatography (HPSEC) method for determination of peak maximum molecular mass (Mp), weight average molecular mass (Mw), number average molecular mass (Mn), and molecular mass distribution (MMD) in Low Molecular Weight heparin (LMW heparin) has been developed and validated on two Ultrahydrogel 250 (ID 7, 8 mm, length 30 cm) columns in series at three laboratories using different equipment. The calibration is based on four local laboratory heparin standards with relatively narrow molecular mass distribution and Mp covering the range from 3,000 to 17,000 Da. The calibration curve describing the logarithm of the molecular mass versus retention time is linear in the range 3,000 to 17,000 Da. The precision (relative standard deviation) within-run and between-run is better than 2%. The between-laboratory variation is below 5%, 3% and 8% for Mp, Mw and Mn, respectively. This method is reproducible, rugged, and fast and is suited for the determination of average molecular masses and molecular mass distribution of LMW heparins on a routine basis.

Automated method for the determination of angiotensin-converting enzyme in serum

A method for the determination of angiotensin-converting enzyme in serum (S-ACE; EC 3.4.15.1.) with use of 3-(2-furylacryloyl)-L-phenylalanyl-glycyl-glycine (FAPGG) as substrate has been adapted for the Cobas Bio microcentrifugal analyser. The method allows 24 determinations per hour in a sample volume of 28 microliters with a within run precision of less than 3% and a between run precision of less than 5%. The reaction is linear up to at least 470 U/l. The reference interval in 92 blood donors has been determined to 14-110 U/l. The method correlates well with the manual method of Hurst & Lovell-Smith (r = 0.982). We have found the method excellently suited for routine assay.

Fatty acid composition of subcutaneous adipose tissue in mother-infant pairs

The fatty acid composition of microsamples from 10 AGA term, 8 SGA term, 7 AGA preterm and 4 SGA preterm, 2-4 day old infants and their mothers were analyzed. In AGA preterm newborns the mean percent of palmitic and stearic acid was lower and the mean percent of linoleic acid was higher than in AGA term infants indicating that there is an increase in fatty acids derived by synthesis from glucose throughout gestation. SGA infants had relative amounts of palmitic and stearic acid similar to what was found in AGA term infants. This indicates that the enzymes involved in synthesis of fatty acids from glucose are intact in intrauterine growth retardation (IUGR). The absolute amount of adipose tissue and fatty acids, however, is smaller in SGA infants due to a reduced availability of glucose in IUGR gestation. No differences were found in the fatty acid composition of subcutaneous adipose tissue from the mothers in the 4 groups. All mothers had a lower mean percent of palmitic and stearic acid and a higher mean percent of oleic and linoleic acid than their infants, ensuring a transplacental gradient to the fetus of this latter essential fatty acid. The fatty acid composition of plasma free fatty acids generally reflected the composition of the subcutaneous adipose tissue in the infants.

Fatty acid changes in plasma lipids and lymphocyte phospholipids after infusion of intralipid to newborn infants

The fatty acid composition of the major plasma lipids and blood lymphocyte phospholipids was studied in four patients before and after 1 month of parenteral nutrition including 2 to 3 g/kg/day of Intralipid fat and in four matched controls before and after 1 month of breast-feeding. After treatment with Intralipid the concentration of polyunsaturated fatty acids including linoleic acid increased in all plasma lipids. The total concentration of polyunsaturated fatty acids in lymphocyte phospholipids did not change. The increase of linoleic acid and decrease of arachidonic acid in lymphocyte phospholipids were not statistically significant. In control infants the concentration of polyunsaturated fatty acids including linoleic and arachidonic acid in lymphocyte phospholipids increased after 1 month of breast-feeding to almost the same values as in the patients. The study indicates that at least in lymphocytes the incorporation of polyunsaturated fatty acids is actively regulated. The present way of administering Intralipid does not seem to cause any abnormal fatty acid pattern of the plasma and lymphocyte lipids. The use of intravenous fat emulsion with high content of linoleic acid in term newborns should thus not be expected to result in changes of the physical-chemical properties of membranes and membrane dysfunction.

Changes in plasma lipoproteins from first day to third week of life in healthy breast-fed infants. II. Fatty acid composition of lipoprotein triglyceride- and cholesterol esters

The fatty acid composition of plasma lipoprotein-triglyceride (TG) and -cholesterol ester (CE) was studied in seven healthy breast-fed infants three times during the first day and on the third, sixth and twenty-first days of life. The major finding was a two-fold increase in the linoleic acid weight percent of plasma lipoprotein-TG and -CE between the first and third weeks of life. This increase could best be explained by the ingestion of breast-milk rich in linoleic acid.

Changes in plasma lipoproteins from first day to third week of life in healthy breast-fed infants. I. Lipid and protein composition of lipoproteins

Plasma lipoproteins were measured in seven healthy breast-fed infants three times during the first and on the third, sixth and twenty-first days of life. Plasma total beta-lipoprotein, very low density and low density lipoprotein increased three times during the first week of life. Plasma total apolipoprotein A-I and high density lipoprotein increased twice between the first and third week of life. These dramatic changes in plasma lipoprotein concentrations during the neonatal period can best be explained by the effect of feeding.

Serum lipoprotein and lymphocyte LDL receptor studies in parents and children with heterozygous familial hypercholesterolaemia

In certain cases heterozygous familial hypercholesterolaemia (FH) cannot be confidently diagnosed from elevated serum lipid and lipoprotein values alone because of overlap with normal values. In the present study, therefore, lymphocyte high-affinity LDL receptor degradation of 125I-LDL was measured in 36 subjects from nine FH families. In eight families there was a good agreement between elevated serum lipid and lipoprotein values and reduced 125I-LDL degradation. In the ninth family, however, LDL receptor activity was normal in three subjects from three generations with elevated serum lipids and lipoproteins. The data suggest a disorder of LDL metabolism other than FH.

LDL receptor studies in term and pre-term infants: Measurement of sterol synthesis in cord blood lymphocytes

Low density lipoprotein (LDL) receptor activity was measured in lymphocytes from pre-term and term infants in order to elucidate if the hypercholesterolemia found in pre-term infants might be secondary to a block in cholesterol transport across the cell membrane, analogous to that seen in familial hypercholesterolemia (FH). LDL receptor activity was found to be fully developed in pre-term infants and no different from that of term infants and of a normal adult control.

LDL receptor studies in children with heterozygous familial hypercholesterolemia (FH): measurement of sterol synthesis in blood lymphocytes

Sterol synthesis was measured in lymphocytes from 48 members of 10 families with familial hypercholesterolemia (FH) under three sets of conditions. First the synthesis of LDL receptors and sterols were maximally stimulated by incubation of lymphocytes in lipoprotein-deficient serum. Secondly sterol synthesis was suppressed by the addition of LDL and thirdly sterol synthesis was maximally suppressed by the addition of 7-ketocholesterol. In five of the ten families LDL suppression of sterol synthesis in FH heterozygotes was only about half of the LDL suppression in normals. In four families, however, there was a considerable overlapping of LDL suppression in FH heterozygotes and normals. Finally in one family LDL suppression was strictly normal in FH heterozygotes who thus appear to have a different type of FH not involving an impaired LDL receptor function.

The fatty acid composition of serum low density lipoprotein- and lymphocyte cholesterol esters in children with heterozygous familial hypercholesterolemia

The content of free and esterified cholesterol in serum low density lipoprotein (LDL) was measured in 19 children with heterozygous familial hypercholesterolemia (FH) and in 10 normal siblings. In FH both free and esterified cholesterol were found to be elevated. Furthermore the fatty acid composition of serum LDL- and lymphocyte cholesterol esters was determined. However, no difference was found between FH heterozygotes and normals thus indicating that LDL-hypocatabolism typically found in FH does not correlate with an abnormal fatty acid composition of LDL-cholesterol esters nor with an impaired cholesterol esterification intracellularly in lymphocytes.